Transplantation of feces, via colonoscopy, can cure patients with recurring Clostridium difficile infection (CDI) — even those with the virulent C difficile 027 strain—according to the March issue of Gastroenterology.
CDI is a common cause of diarrhea in patients taking antibiotics. Infections have recently become more frequent, severe, refractory to treatment and likely to relapse. Patients with CDI are usually treated with metronidazole or vancomycin, which are not always effective—the infection recurs in almost half of the patients that receive these antibiotics, probably because they alter the normal flora, which protect the intestines against C difficile and other pathogenic bacteria.
Scanning electron micrograph of Clostridium difficile bacteria from a stool sample. Obtained from the CDC Public Health Image Library.
The idea that re-establishing the normal composition of the intestinal flora by transplanting feces from a healthy individual was first proposed in 1958. However, few studies have been published on the efficacy and safety of fecal transplantation for recurrent CDI. Different transplantation methods have been described, including stool infusion to the duodenum through a nasogastric tube or fecal enemas.
Eero Mattila et al. collected and analyzed data from 70 patients (an average age of 73 years old) with recurrent CDI who were treated with colonoscopy-administered stool (infusing fresh donor feces into cecum) at 5 different centers. Before transplantation, the patients had whole-bowel lavage with polyethylene glycol solution; they were followed for 1 year.
Within the first 12 weeks after fecal transplantation, symptoms resolved in all 34 patients (100%) who were not infected with 027 C difficile—a particularly virulent strain that is more difficult to eradicate and has a higher rate of recurrence.
Of 36 patients with 027 C difficile infection, 32 (89%) had a good response to the fecal transplant. The 4 patients that did not respond had serious, pre-existing conditions and subsequently died of colitis.
In the first year following the transplantation, 4 of the 34 patients whose symptoms initially resolved underwent a relapse after receiving antibiotics for unrelated causes. Two of the patients were treated successfully with another fecal transplantation and 2 with antibiotics for CDI.
In the course of the year after transplantation, 10 patients died of unrelated illnesses, but no immediate complications of fecal transplantation were observed.
Mattila et al. state that transplant by colonoscopy offers advantages over other procedures in that causes of long-term diarrhea such as inflammatory bowel disease or disorders such as diverticulosis can be ruled out. They propose that the lavage performed before the colonoscopy reduced colonic biomass and facilitated restoration of the colonic bacterial flora. They also recommend using fresh instead of frozen donor stool for the transplant, because bacteria are more viable.
The major risk of the procedure is transmission of contagious agents that do not cause disease immediately after transplantation but could complicate future therapies, such as multidrug-resistant, gram-negative bacteria. Mattila et al. say that long-term studies need to be performed to address these issues, and donor stool samples should be tested for multidrug-resistant bacteria.
However, Mattila et al. state that no transmitted infections or significant immediate adverse effects have been reported for this procedure, so far, and that fecal transplantation appears the best treatment approach for recurrent CDI.
Read the article online.
Mattila E, Uusitalo–Seppälä R, Wuorela M, et al. Fecal transplantation, through colonoscopy, is effective therapy for recurrent Clostridium difficile infection. Gastroenterology 2012;490–496.
Kristine Novak, PhD, Science Editor
Can you help
Millie has been suffering from c-diff since early may,she has been on vancomycin since,every time she comes of this becomes very poorly we are very worried the doctors are going to withdraw this medican and Millie will be left to deteriorate,she is suffering from metachromatic leukodystrophy
FO MILLIE = go for the fecal infusion.I’m 81 – was very very sick with constant recurrences after each attack. The thought at first really sounded disgusting but I could not live with the disease ‘ The process was easy – not at all what I had imagined and so far, so good. Good luck -
Millie, GET THE TRANSPLANT!! I am the afraid of everything and I had one. It was as easy as going to sleep and waking from a nightmare. I don’t know of the condition described above, but considering her age do it now. Why live the end of her twilight years with cliff, when there is a simple cure. Find a Dr., he will do it soon and she will be free of it. Best of luck, and I will pray she has the strength to do it.
How do I find a doctor in Southern California. Suffering for 3 years with c-diff.
I have had c-diff sence October and Iv been on Meds for it over three times, I just went to a G I Dr and he put me back on flagel and vanco again, He did say if this doesn’t work we will do the Stool transplant. Im so tired of having the Diahreea no one knows.. any syggestions PLease !!
Dear Pat,
I have had C-Diff since Christmas 2012 and this is 3-18-2013.
I have had 3 – 14 day doses of vancomycin since being hospitalized 9 days on IV Flagil and other stuff. I have a doctor here in Michigan that will do a stool transplant and perhaps that will be my next move. I understand your frustration and hope you find relief very soon.