Fecal Transplant Shown to Be Effective against Even Severe Cases of C. Difficile Infection

Intestinal microbiota transplant is a viable option for patients with C. diff infection who have not responded to conventional treatment.

Most family members readily agree to become stool donors when someone they care about is afflicted with diarrhea-causing Clostridium difficile, according to a researcher who presented data from a retrospective study on stool transplant at IDWeek 2012, the first joint annual meeting of the Infectious Diseases Society of America (ISDSA), Society for Healthcare Epidemiology of America (SHEA), HIV Medicine Association (HIVMA), and Pediatric Infectious Diseases Society (PIDS).

Also called C. diff for short, the bacteria can linger in the body and cause bloating, diarrhea, and inflammation of the colon. It is commonly spread in hospitals by health care workers who have touched a contaminated surface.

Conventional treatment of C. diff infection (CDI) with metronidazole and vancomycin doesn’t always work. Fecal transplant, also known as intestinal microbiota transplant (IMT), is one treatment method gaining momentum because it combats the nasty germ by restoring normal fecal flora through intestinal microbiota, said Laila Shiekh Sroujieh, MD, and Mona Hassan, MD, who presented research on two retrospective studies.

While the procedure has successfully treated stable patients infected with C. diff, researchers wanted to further test its use for severe cases. The objective of the study was to assess the efficacy and safety of IMT performed at the 900-bed Henry Ford hospital in Detroit.

The first study was conducted between May 2010 and June 2012 among patients who had not responded well to conventional treatment. Healthy people, most often family members, donated the stool that was transplanted, said Haddel Zainah, MD, another researcher involved in the study.

In the first study, 49 patients with moderate to severe CDI underwent IMT. All of the patients tolerated the procedure well, without adverse events and recovered within one to four days after the transplant. Symptoms resolved for 46 of the patients and three patients died from unrelated causes. The second study enrolled 15 patients from the original study and specifically targeted severe/fulminant cases of CDI with similar results. The median age of patients was 66 in the first study and 60 in the second.

Researchers pointed out that unlike other studies that blended the stool, their procedure used simple tools (a few cups and gauze for filtering), making it easy to duplicate in similar studies. The healthy stool was transplanted with a water flush either through a nose tube or colonoscopy.

Zainah said typical donors were health family members who didn’t mind donating stool because they were eager to help their loved ones suffering from the CDI symptoms.

Researchers concluded that the procedure is safe and effective in inpatient and outpatient settings. They said further studies are warranted to consider IMT as a first-line therapy in patients at high risk for recurrence. The study limitations included that it was conducted at a single center without a control group.