Clostridium difficile infection, also known as C. difficile or C. diff infection, is a condition marked by medical issues ranging from severe diarrhea to life-threatening inflammation of the colon. It can be extremely difficult to treat, which is why the results of two studies about fecal transplants are so encouraging.
C. diff infection is most common in patients with a history of long-term antibiotic use, particularly broad-spectrum antibiotics. It also most frequently affects the elderly and individuals who are hospitalized or in long-term care facilities.
According to the Centers for Disease Control (CDC), C. diff returns in about 20 percent of cases. In a small number of patients, the infection returns over and over and can be quite debilitating.
The CDC goes on to say: “Transplanting stool from a healthy person to the colon of a patient with repeat C. difficile infections has been shown to successfully treat C. difficile. These ‘fecal transplants’ appear to be the most effective method for helping patients with repeat C. difficile infections.”
Researchers recently looked at the initial and sustained responses of 58 patients who underwent fecal transplants for C. diff infections and found that cure rates remained high up to 18 months post-transplant.
In discussing the study, Dr. Daniel Greenwald, internal medicine resident at Lahey Hospital and Medical Center in Burlington, Massachusetts, told Medscape Medical News: “We looked at a very sick cohort of patients, in that they had either recurrent or refractory (resistant to treatment or cure) C difficile, and we saw a 91.4 percent primary response rate at three months, an 86.2 percent response rate at six months, and an 80.5 percent response rate at 18 months, which I think is very telling of the effectiveness of FMT (fecal transplant), even in sick patients who had failed primary, secondary, and in some cases, tertiary treatment options with antibiotics.”
The study showed patients were more likely to have a recurrence of C. diff if they subsequently used antibiotics to treat another illness or had a comorbid gastrointestinal illness – meaning to exist simultaneously with and typically independently of another medical condition – such as celiac disease.
In a separate study, a team led by Dr. Mark Mellow, a gastroenterologist in Oklahoma City, followed 94 patients who had undergone fecal transplants for the treatment of recurrent C. diff infection. Mellow reported the results from his study and that of Greenwald were nearly identical.
At 17 months, the only patients that suffered a late recurrent C diff. infection were those who had been treated with antibiotics for some other condition. Patients who did not take subsequent antibiotics remained free of the infection.
“So the message to physicians, especially those caring for people in long-term care facilities, is to use antibiotics very, very judiciously, to use as narrow-spectrum an antibiotic as possible, and for as short a period of time,” Mellow said.
I agree with Mellow’s advice. It also is important for patients to take only antibiotics as prescribed by their doctor. Everyone needs to wash their hands thoroughly, especially before eating or after using the bathroom. Hand-washing by medical staff members remains the most effective means of stopping the spread of illness within medical facilities.
Gastrointestinal Associates is proud that we have never had an occurrence of C. difficile infection. You can learn more about our safety protocols by reading a blog post on the subject authored by Dr. Charles O’Connor.