Author – Clifford McDonald MD
Prevention and Response Branch Chief
CDC’s Division of Healthcare Quality Promotion
Transplanting feces from one human to another may sound repulsive, but for patients suffering from recurrent, debilitating diarrhea caused by Clostridium difficile, a fecal transplant offers a ray of hope.
It increasingly appears that fecal transplants are effective in treating recurrent CDI. Though we await randomized controlled trials to confirm signs of efficacy, we at CDC are heartened by this potential treatment. Also, we are encouraged by our rapidly increasing understanding of the human microbiome, a term that refers to the entire population of microorganisms living on or inside us and all the genetic information possessed by these microorganisms.
In a recent paper in Clinical Infectious Diseases, Dr. Pritish Tosh and I lay out a framework for the importance of a healthy intestinal microbiome to fight off a large and growing number of multidrug-resistant organisms (MDROs). We believe that the main effect of antibiotics resulting in drug-resistant organisms is “selective pressure on the human microbiome.” When antibiotics wipe out the good bacteria of the microbiome, those bacteria are replaced by organisms that survived the antibiotic treatment, namely MDROs. Once colonization with resistant organisms has occurred, these bad bugs can multiply and, in some cases, cause untreatable or severe infections. These infections include colitis from C. difficile, in addition to bloodstream infections, pneumonias and other serious infections caused by MDROs.
Restoring a person’s inner population of normal bacteria holds promise for sufferers of CDI and for preventing MDRO infections. We need to know more about fecal transplants and the role of a healthy microbiome to bring this science to the bedside. To speed this process, CDC is working with other government agencies, the NIH and FDA, to translate microbiome science into practical infection prevention. While that technology may be several years away from common use, it holds promise as one more tool we can use to protect patients from the increasing threat of these difficult to treat infections.