… including (apparently) poop. In a recent article on the CBC.ca website, called “Don’t poo-poo technique: fecal transplant can cure superbug, doctors say” (follow the link at the end of the post to read the actual article) by ??, it was reported that doctors have performed several of these fecal transplants … I’m not sure how to react to this. It’s like part revulsion and part morbid curiosity and, like you, I proceeded to read on.
The treatment (the fecal transplantation) is used in cases of Clostridium difficile infection. C.difficile is a bacterium that infects the gut and causes diarrhea as well as other serious intestinal conditions including toxic megacolon which is a medical emergency. It is, unfortunately, the most common cause of acquired hospital infection in Canada (as well as the rest of the industrialized world). It is the type of bug that is opportunistic and when the normal flora of the intestine is disrupted by something like illness or antibiotics C. difficile can take advantage and colonize the gut leading to an acute illness.
“Clostridium difficile is a superbug that commonly spreads in hospital settings and has been linked to the deaths of at least 2,000 people in Quebec since 2003, as well as in other provinces.”
Problems begin to arise when you consider treatment. As far as I understand, the patient must discontinue using their current antibiotics and start an another (Metroidazole or Vancomycin) which is more specific to killing the bug. Even with treatment C. difficile infections can persist.
“The antibiotics sometimes wipe out the good bacteria but fail to completely kill the C. difficile – leaving enough of it that it later flourishes. “
Right – conventional treatments may not result in a complete cure and, up until now, I didn’t think there was an alternative type of treatment. How wrong I was! Some of the more scatologically inclined doctors in Scandinavia have been working on fecal transplants as a way to cure the infection. Not to be outdone the technique has found its way to the United States and now is even available in Canada.
“Calgary physician Dr. Tom Louie, head of infection control at Foothills Hospital, is one of the few physicians in Canada who treats patients with chronic C. difficile with fecal transplants, or fecal therapy. He has done 38 procedures to date. “
Call me crazy but before you volunteer you may want to look at the studies out there …
Studies that have been published show that more than 90 per cent of patients are cured through fecal transplants – most of them after just one treatment.
Interesting … there is nothing in pubmed, nor UpToDate and a Google search doesn’t turn up any scientific literature. There are passing comments made on the Clinical Infectious Diseases 1999;29:000 hotpage.
A recent discussion from the EIN Bulletin Board raised an option of “fecal transplants” that was claimed to have extremely good results, often with complete relief, within 24 hours, of diarrhea of months’ duration.
At a lecture at the German Anaerobe Society meeting held in Leipzig, Germany, Prof. Carl Eric Nord (Sweden) noted that they too have performed successful fecal implants to cure recurrent C. difficile diarrhea. They even maintain their own collection of total fecal flora and various components.
There was also an article published online, 21 November 2006 titled “Emerging Therapies in the Treatment of C. difficile-associated disease from The Annals of Pharmacotherapy (Vol. 40, No. 12, pp. 2164-2169.), which mentions fecal transplantation as a nonstandard strategy.
Hmmm … so maybe I’m going to wait until more studies have been done before I volunteer. Regardless it’s an interesting idea of how to treat a serious infection in a rather non-conventional way.
Read the CBC article here for more information …
5 responses so far ↓
Chris // January 28, 2008 at 2:13 am |
Found your post by searching out cures for this. My dad is 11 years post heart transplant and currently 12 days into intestinal distress. They’ve not diagnosed C Diff, but I wouldn’t be surprised. Just wondering if you’ve come across any discussion of using an enema of probiotics rather than fecal matter? Seems like a cleaner solution to me! And less dangerous for immunocompromised transplant patients. Any thoughts? Thanks-
docwalk // February 4, 2008 at 5:20 pm |
This is the response I sent to Chris – for any others that are interested. I want to preface this comment by saying that I’m only a second year student so my interest in more academic than anything else. If there are serious questions concerning this type of treatment it’s best you talk to a physician. So having said that …
I haven’t come across anything relating specifically to probiotic enemas used as an alternative to “fecal transplants”, in fact I was wondering about the same thing myself. Wouldn’t it make more sense to simply culture and re-introduce the bacteria into the colon without the feces?
There have been a number of studies which looked at a variety of probiotic cultures in the treatment and prevention of antibiotic associated diarrhea. Unfortunately, the quality and quantity of studies is limited which makes it hard to draw any definitive conclusions. It seems like we’re still in the evidence gathering phase and there is not enough data to conclusively make priobiotics a recommendation for antibiotic associated diarrhea. With respect to diarrhea caused specifically by C. difficile, the studies are inconclusive and show no benefit for treatment or prevention. Unfortunately, there is also a case study which showed that a certain strain of probiotic culture was dangerous in immuno-suppressed and critically ill patients [Munoz, et al., Clin Infect Dis 2005 Jun 1;40(11):1625-34.]
Since posting about fecal transplants I have actually come across some additional information on the subject. “Fecal bacteriotherapy” as it’s known as is used in the treatment of recurrent Clostridium difficile infection. It is a means of restoring the “entire” bacterial flora of the colon as opposed to any one species in particular. It is indicated for patients suffering from severe and recurrent C. difficile infection which is refractory to conventional treatments. However, it should be noted that Fecal bacteriotherapy is a weak recommendation with evidence coming from either observational studies or unsystematic clinical experience. Without more data any estimate of effect is uncertain.
So – I’m not sure if this was helpful or not. Best wishes to your Dad, Chris – I hope he feels better soon.
laurie kahlich // December 27, 2008 at 2:05 am |
I have had trouble w/c-diff for 1 year now. Would you please tell me where the closest place for these fecal transplants is to where I live. I live in Hereford, Texas and I am seriously considering trying this…….Please help me as I have been off/on Vanco for about a full year now.
Lindsey Kowalchuk // February 1, 2009 at 2:31 am |
Like Laurie I have C-Diff and have been on and off Flagel and Vancomicin for 8 months. Every time I come off of it the C-Diff returns. I’m going to see Dr. Louie on Weds and see about the fecal enema. We’ll see if it works but at this point I’d try anything.
Teresa // March 17, 2009 at 7:02 pm |
My mother has had c-diff for almost a year and recently was put on a drug that is supposed to kill all the spores after being on her umpteenth dose of vancomycin. She is again positive for c-diff and will be getting the fecal implant soon. I am hopeful that this will work as she has lost 40 lbs already and didn’t need to lose any. Are there any risks associated with this treatment? What is the possibility that it won’t work, and if it doesn’t, then what?