Archive August 2017 XVIII, No. 8

Infection Prevention: A Gross Cure for Recurrent C. diff

When antibiotics fail, fecal transplants are remarkably effective.

Jim Burger, Senior Editor

fecal microbiota transplant VILE VIAL Fecal microbiota transplants — whether administered via colonoscopy, upper endoscopy, nasogastric tubes or tablets — have a success rate for resolving recurrent Clostridium difficile of at least 80%.

As cases of recurrent Clostridium difficile infections soar, a promising new treatment has emerged: fecal microbiota transplantation, which is exactly as it sounds — lining the colon of a C. diff-infected patient with slurried stool from a healthy donor after antibiotic treatments have failed.

The donor stool is diluted with a saline or other solution and strained before it's placed in a patient — usually by colonoscopy, nasogastric tube or capsule. The idea is to fight off C. diff by repopulating the digestive tract with good bacteria that may have been be killed off by antibiotics, according to the Fecal Transplant Foundation (thefecaltransplantfoundation.org).

The power of poop
The incidence of C. diff infections has been rising dramatically in the 21st century. A recent study published in Annals of Internal Medicine tracked the nationwide surge in cases from 2001 to 2012 (osmag.net/9adfcv). By examining data from nearly 39 million patients, researchers found that cases of multiple recurring C. diff had increased by 189%, and cases of common C. diff had increased by 43%.

That translates to hundreds of thousands of patients, and it underscores a phenomenon that's both grave and confounding. Not only do most antibiotics fail to eliminate C. diff — antibiotics are actually the root of the problem. By disrupting the normal community of bacteria in the intestines, they allow C. diff to flourish, resulting in infections that range in severity from bothersome to deadly.

Grasping for treatments, providers have turned to vancomycin and probiotics, both of which have proven only marginally effective. Fecal transplants have had a remarkable success rate of about 80% or higher for resolution of recurrent C. diff, says James D. Lewis, MD, MSCE, one of the study's authors and a professor of medicine and epidemiology at the Perelman School of Medicine at the University of Pennsylvania in Philadelphia, Pa.

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