By: Davidta Brown, Staff Editor

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Pathogenic bacteria have been enemies to human health for centuries. As recently as last month, the Centers for Disease Control published an 80-page document informing the public about America’s biggest microbial threats. Most of the pathogens on the list exhibit antibacterial resistance. One particular bacterial species, ranked at threat level “Urgent” and causing an average of 250,000 infections and 14,000 deaths per year, is known as Clostridium difficile.¹ While the bacterium has not been shown to have antibiotic resistance, its rapid spread makes the pathogen a source of concern to healthcare providers in institutional settings.

C. difficile is an anaerobic, gram-positive bacillus-type bacterium that is capable of forming spores.¹ C. difficile infections are typically spread through these spores, often on the hands of healthcare personnel who have come into contact with surfaces contaminated with fecal matter.² Alarmingly, infection with this bacteria is most common in individuals who have recently received medical care, usually in the form of hospital admittance, and who have been treated with antibiotics for an unrelated infection. There is also a disproportionate age distribution when it comes to C. difficle infections and how severe symptoms are; Almost half of all C. difficile infections are in people over the age of 65, but this age bracket also shows 90% of the cases of death or complications from the infection.¹

Traditionally, C. difficile is treated with a 10-day course of metronidazole, vancomycin, or fidaxomicin.² In some individuals, however, the antibiotics only provide temporary relief, while leaving some unfortunate to suffer from recurring bouts of colitis and “antibiotic-associated diarrhea.”

In the past twenty years or so, a new option for these patients, Fecal Microbiotoa Transplatation (FMT), has proven to be extremely successful in preventing the return of C. difficile. In the new treatment, healthy donor provides a fecal transplant. The reasoning behind the novel treatment is fairly intuitive. Patients suffer from infections only after their natural flora of commensal gut bacteria have been eliminated by antibiotics. If the appropriate bacteria populations were to be re-established, they would consume enough of the resources in the internal environment to prevent C. difficile from gaining a foothold. In essence, the bad bacteria would be starved out by the good bacteria.

Fecal Microbiota Transplantation has shown almost unheard-of success rates as a method of halting recurrent C. difficile infections. In several studies, FMT by colonoscopy or enema has had clinical success rates of up to 95% in patients with recurring colitis. Even more promising, 91% of patients who had undergone one round of FMT had no incidence of relapse, even after three months had passed since treatment administration.³ In this way, FMT has proven to be not only an efficacious therapy, but one in which the benefits of a single treatment are maintained over long periods of time.

Until now, the major disadvantage of FMT (besides initial aversion to the concept) has been the method by which the treatment is administered. As previously mentioned, edema, gastroscopy, and endoscopy methods have all been utilized. Additionally, oral suspensions and infusion via nasoenteric tubes have also been employed.⁴ Understandably, these dosage forms can be difficult for patients, though many who turn to FMT are desperate for any cure.

In response to the difficulty these patients face, Canadian infectious disease specialist, Dr. Thomas Louie, has added simple oral capsules to the variety of methods by which patients may receive FMT.⁵ To prepare the doses, bacterial samples are collected, filtered, and concentrated on site, and then packaged into gelatin capsules for easy transport to the lower intestines. Patients come for FMT treatment on an empty stomach and ingest an average of 24 to 30 capsules.⁵ The burden of taking so many capsules in a single sitting has typically been seen as an improvement over the alternatives, and the long-term benefits have been deemed well worth the inconvenience.

So far, the single dose has proven to be as effective as the more traditional FMT methods, but the new dosage form still needs to undergo the required clinical trials before conclusive evidence of its success can be given. However, at this early stage, the future of gut flora repopulation as a treatment for gastrointestinal disease appears promising. In the long run, bacterial “gardens” will be cultivated in bulk and distributed when necessary. But for now, scientists are content with taking the solution nature has offered and simply changing its packaging.

SOURCES:

1. Centers for Disease Control. Clostridium Difficile. Available at: http://www.cdc.gov/drugresistance/threat-report-2013/pdf/ar-threats-2013-508.pdf#page=51. Accessed October 30, 2013.
2. Centers for Disease Control. Frequently Asked Questions about Clostridium difficile for Healthcare Providers. Available at: http://www.cdc.gov/HAI/organisms/cdiff/Cdiff_faqs_HCP.html. Accessed October 30, 2013.
3. Aberra F, Curry J. Clostridium Difficile Colitis Treatment & Management. Medscape. 2013 Oct [cited 2013 Oct 30]. Available from: http://www.emedicine.medscape.com/article/186458-treatment#showall
4. Brandt L, Aroniadis O. An overview of fecal microbiota transplantation: techniques, indications, and outcomes. World J Gastrointest Endosc. 2013;78(2):240-249.
5. The Canadian Press. ‘Poop’ pills can treat C. difficile, Calgary doctor says. Available at: http://www.bcb.ca/news/canada/calgary/poop-pills-can-treat-c-difficile-calgary-doctor-says-1.1895079. Accessed October 31, 2013.

Published by Rho Chi Post