Stool transplant could provide cure for bacterial infection

Patients with chronic problems caused by life-threatening diarrhea from an overgrowth of a nasty bacteria could be facing an unsavory solution: ingesting someone else’s feces. 

As bad as it sounds, researchers at the University of Alabama at Birmingham say fecal transplant, which is administered through a tube or a colonoscopy, can help restore the healthy balance of bacteria needed to overcome problems posed by clostridium difficile infections, which are linked to diarrhea that kills 14,000 people a year.

The problem stems from the widespread use of antibiotics to control bacteria and treat disease, which has led to overuse.

“Patients were trained that if you go to your doctor with something and you don’t leave with a prescription, then you’re not being fully treated,” said Dr. Craig Smith, the medical director for infectious diseases at University Hospital and chairman of the Georgia Healthcare-Associated Infec­tion Advisory Committee.

It’s not just the prescription antibiotics the patients are taking, he said.

“You also have to consider the literally tons of antibiotics used in agriculture, to have healthy meat, to have healthy milk, to have high-production farms,” Smith said.

That can have a big impact on the up to 100 trillion bacteria inside the colon, said Dr. Casey Morrow, a professor at the UAB School of Medicine.

“We’re inhabited by a huge number of microbes that we carry around with us,” he recently told a gathering of the Association of Health Care Journalists. “These are actually interacting with us” in functions such as digestion and absorption of nutrients. A healthy population would have a wide variety of bacteria, but antibiotics can wipe out many of the species, allowing resistant and virulent strains, such as clostridium difficile, to run wild.

Treatment with other antibiotics can often bring that infection under control, but in about 30 percent to 40 percent of cases the bacteria have become resistant and diarrhea and other problems persist, said Dr. Sa­tish S.C. Rao, the chief of gastro­enterology/hepatology at Geor­gia Regents Univer­sity.

The simplest solution would be to bring back the previous balance, Morrow said. A fecal transplant, rich in bacteria, seemed to be the solution.

A couple of landmark studies seemed to show that grinding up the stool of a donor – preferably someone close to the patient – mixing it into a solution and applying it through a colonoscopy appeared to work in stubborn bacterial infections, Rao said.

“They showed some dramatic improvement,” he said.

A New England Journal of Medicine review of 500 patients showed a cure rate of 80 percent to 90 percent, said Dr. Martin Rodriguez, an associate professor in the Division of Infectious Di­seases at the UAB School of Medicine. His institution has done eight such treatments, and for many a response is seen within hours or a day or two.

UAB has been administering a “microbiome transplant” through a feeding tube, and Rodriguez said some people just can’t deal with that.

“Some patients are like, ‘I’ll continue to have diarrhea and see how it goes,’ ” he said.

Georgia Regents Medical Center found the treatment helped one patient who had been hospitalized there three times and at every other hospital in Augusta, Rao said. The institution has created protocols by screening potential patients and donors and now, with less rigorous requirements from the FDA, stands ready to do more, Rao said.

The FDA told the Ameri­can Gastro­entero­lo­gical Asso­cia­tion last week that the treatment could be given with just informed consent from the patient. Previously, it said the treatment should be treated like a clinical investigation.

Smith said others have talked to him about doing the procedure at University Hos­pi­tal, but he said he has not had a patient who couldn’t be helped with antibiotics, and he would like to see more thorough research.

“I think that scientifically it makes sense,” Smith said. “But I think it is still a new therapy that is in evolution.”

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