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Using fecal transplants to treat recurrent Clostridium difficile infections (CDI)

Categories: Antimicrobial Resistance, Clostridium difficile

Clifford McDonald, MD

Clifford McDonald, MD

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. 

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  1. April 24, 2012 at 6:17 am ET  -   CJ Hanscom

    Where are fecal transplants being performed? My GI’s office staff had never heard of this treatment much to my disappointment and dismay.

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  2. March 27, 2012 at 8:32 am ET  -   Reg

    My 19 y/o daughter has been suffering from C.Diff for many months since being hospitalized last June after a bad car accident. She has had several rounds of Vancomycin and finally underwent a fecal transplant on March 1st, 2012, via colonoscope. After three weeks with no symptoms she once again began having symptoms of C.Diff. – bloody diarrhea, and last night extreme abdominal pain accompanied by a very high fever. She is in the Hospital now where they will test to confirm C.Diff. It was just over three weeks since the transplant procedure so we are really shocked it has apparently come back. Not sure what the next course of action will be but we really need to get this cured. Perhaps another fecal transplant?

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  3. March 12, 2012 at 5:58 pm ET  -   Traci

    This research is intriguing and brings hope to people suffering from this awful illness. Its an exciting time to be a healthcare provider and see the new and improved treatments of today.

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  4. March 8, 2012 at 4:21 pm ET  -   Joy

    The research and outcome of curing C. diff with this transplant method is very intriging. I have never heard of this technique as a cure. It is a very interesting article.

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  5. February 1, 2012 at 7:32 am ET  -   Healthcare

    Nice description. This section gives information about the entire biological process, biological variations due to organism. If the role of bio organism in variation process is mentioned, then people will get to know the exact matter.

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  6. January 22, 2012 at 5:43 pm ET  -   David Smith

    Dear Clifford,
    while studying for my B.Sc in microbiology at Bristol uni (UK) during ’80 – ’83 I learnt a term called commensals which is I believe what you call the microbiome. Commensals competitively inhibit the growth of pathogens until we employ the use of antibiotics. After this there are no organisms to compete with the pathgens to inhibit their growth. An example of this is the lack of Doderleins bacillus which occurs naturally in the vagina. After antibiotics pathogens change the optimum PH needed for colonisation by the Doderleins. This can be restored by applying natural yoghurt to the infected area.
    Maybe an inocculum of colonic bacteria such as Escherichia coli (E. coli) coliform bacteria found in the gut and stools occuring as commensals would inhibit the growth of C. difficile. My thesis was entitled the differential inhibitory effects of teracycline on protein synthesis in E. coli.
    Best wishes
    David Smith

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  7. January 18, 2012 at 1:30 pm ET  -   Nato Tarkhashvili

    Hi Clifford,
    Thanks for writing such a wonderful article. Originally I am from Georgia (the country) and conditions that you are talking about in this article we call “disbacteriosis”. We studied this problem extensively and I think it is still studied there. Disbacteriosis was defined as a changing landscape (both: qualitative and quantitaive) of enteric microflora (we focused primarily on enteric microflora). Disbacteriosis was treated with probiotics, e.g. Bificoli, which is a combination of Bifidobacteria and E. coli, I guess).
    Thanks,
    Nato

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  8. January 17, 2012 at 3:25 pm ET  -   Scott Stienecker MD FACP FSHEA

    I have been performing fecal transplants for about 5 years. In general, we have experienced about a 90% cure rate. I have not had success when the patient has concurrent Crohn’s disease or in patients with non-C Diff related chronic diarrhea (post-salmonella). I have had the most success in the elderly ECF patient with diarrhea > 6 months. They are vancomycin responsive, but many of them don’t necessarily have a positive C Diff toxin assay. They do respond very well, gaining weight and strenth. It is rewarding to see them leaving the ECF for home with diarrhea cured. I attribute this group to “altered microbiotia” of the intestine.

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  9. January 17, 2012 at 2:27 pm ET  -   Kathleen Wold

    I remember a nursing instructor in the 1970′s saying she was taught to fill an empty pill capsule with stool and gave it to patients with diarrhea. (The instructor went to nursing school in the 1940′s.)

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