Fecal microbiota transplantation is proving successful at treating Clostridium difficile infections, according to a recent study in the American Journal of Gastroenterology.
The study, published online June 3, focused on immunocompromised patients a population particularly vulnerable to CDI, according to researchers. Among the 80 patients studied, which included five pediatric patients, 36 had inflammatory bowel disease, 19 had received organ transplants, seven had cancer, three had AIDS or were HIV-positive and 15 had other medical conditions or were taking other medications, according to the study. The follow up range post-transplant was between three and 46 months.
The cure rate after a single fecal transplant was 78%, with 62 patients suffering no recurrence of CDI, the study stated. Because eight of 12 patients who underwent repeat transplants had no further incidents of CDI, the study found, the overall cure rate was 89%. Two patients died, with one of the deaths occurring from aspiration during sedation from fecal transplantation administered by colonoscopy, according to the study. Still, the study found that fecal microbiota transplant appears to be a safe and effective procedure for immunocompromised patients. The study also found that those patients do not appear to be at high risk of infection from fecal transplant procedures.
Patients with CDI are missing certain gut flora, usually as a result of antibiotic use, Robert Orenstein, DO, of Mayo Clinic in Arizona, said in an article on the clinics website. I suspect some kind of signaling takes place between healthy bacteria and the mucosa of the gut, and without that signaling, C. difficile can take over. Restoring the missing flora seems to be the key.
The procedure is performed through nasogastric tube, nasojejunal tube, upper tract endoscopy, colonoscopy and retention enema, Orenstein said. He prefers colonoscopic infusion, calling it the safest and most effective way to deliver healthy bacteria to the site of most C. difficile infections, according to the Mayo Clinic website.
If something goes wrong with nasogastric insertion, the complications could be disastrous, Orenstein said in the Mayo Clinic article. And implanting stool in the small bowel might lead to bacterial overgrowth. We dont know, but that would be one of my concerns. From our experience, the terminal ileum is the optimal site.
The Fecal Microbiota Transplant Team at the Mayo Clinic in Arizona performed its first colonoscopic fecal transplant in 2011 on a patient with severe refractory CDI, using donated stool from the patients brother, according to the clinics website. Since then, the clinic has performed 24 fecal transplants for CDI patients.
Read the full study at http://www.nature.com/ajg/journal/v109/n7/full/ajg2014133a.html.