The practice of infection control usually focuses on preventing the spread of microbes. However, new treatments have emerged that actually use microbes to help cure certain infectious diseases.
One of these infections is caused by Clostridium difficile, a bacteria that causes infection in a person’s intestinal tract, producing inflammation in the colon, abdominal pain, and watery diarrhea. C. difficile infection (CDI) standard treatment includes weeks of oral antibiotic therapy, but for up to 25 percent of patients, the infection relapses and requires multiple rounds of oral and invasive antibiotics to cure the infection. For some patients, antibiotics can only keep the infection at bay but cannot completely eradicate it. Patients are forced to continue taking antibiotics or risk a relapse of CDI.
Fecal Microbiota Transplant (FMT) is a newer treatment that takes the stool of a healthy donor, preferably from a close relative or spouse, and transplants it into the gut of the CDI patient. The methods of delivery can vary, but the stool is usually transplanted by placing a tube that delivers the stool directly to the gut. The bacteria in the stool transplant overtakes the bacteria in the patient’s gut, including the C. difficile bacteria.
If the transplant was a success, then the patient sees resolution of the symptoms in a few months. The success rate of the FMT procedure is very high, with about 85 percent success in eradicating CDI in over 7,000 patients. However, since FMT is a relatively new procedure, there is little data on long-term risks of complications and overall prognosis of patients that have had a transplant.
The success of FMTs is one of the first examples of fighting bacterial infections using bacteria instead of the historical standard practice of using antimicrobial therapy. Given the success of FMT, I imagine we will see more efforts in trying to fight infections using this approach.
Brandt LJ, Aroniadis OC, Mellow M, et al. Long-term follow-up of colonoscopic fecal microbiota transplant for recurrent Clostridium difficile infection. Am J Gastroenterol. 2012 Jul. 107(7):1079-87
Cohen SH, Gerding DN, Johnson S, et al. Clinical practice guidelines for Clostridium difficile infection in adults: 2010 update by the Society for Healthcare Epidemiology of America (SHEA) and the Infectious Diseases Society of America (IDSA). Infect Control Hosp Epidemiol 2010; 31:431–55.
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