Faecal Transplant by Enema Works for Stubborn C. Difficile.
I have previously discussed the use of faecal transplant therapy as an effective treatment for the pervasive infectious agent C.Diff. This is a serious often difficult to resolve bacterial infection that occurs primarily whilst patients are hospitalised but is not limited only to residential care.
C. difficile infections tripled between 1996 and 2005, and they now affect about 84 out of every 100,000 people.
Multiple antibiotics are used with declining efficacy to resolve this fatal infection, often with the unwanted side effect of further loss of microbiological stability in the mucosal tissues. Adding probiotics or saccharomyces in the primary infection do not seem to make the antibiotic therapy any more effective, but may diminish the change in bacterial composition.
However, if the antibiotic route has been exhausted the use of faecal transplantation is then suggested more and more frequently. It seems odd to me that a simple enema based transplant of healthy and screened faecal material should not be offered early in the treatment as the rate of success far exceeds that of antibiotic therapy. It is low cost, low risk and whilst perhaps for delicate stomachs a little ‘icky’ it works.
A recently published study in the Arch Internal Med journal has demonstrated once again that 9 out of 10 patients that have failed to respond to antibiotics do respond to faecal transplantation.
Clostridium difficile infection (CDI) is the leading cause of nosocomial infection and its rates continue to rise. In the United States, the incidence of CDI tripled between 1996 and 2005 (31 per 100 000 vs 84 per 100 000). This has been accompanied by an increase in disease severity, with mortality rates of up to 6.9%. In addition, nosocomial CDI increases the cost of otherwise matched hospitalizations by 4-fold.
Metronidazole therapy failure rates for uncomplicated CDI have risen from 2.5% to higher than 18% since 2000. Recurrence rates are as high as 50% in patients older than 65 years and exceed 60% after 2 or more recurrences. Accordingly, faecal transplant (FT) serves as an alternative approach. While antibiotics can further disrupt the microbiome, FT aims to reconstitute healthy flora.
In the this study, led by Dr. Christine Lee at McMaster University in Hamilton, Ontario, researchers asked two healthy volunteers to donate faecal matter, which was diluted in water and used to treat 27 patients with refractory C. difficile infection.
Unlike earlier studies that have used a colonoscope or a nasogastric tube, Dr. Lee’s group used an enema to deliver the faeces.
All but two patients recovered after the procedure, and the vast majority felt better within one day.
How, exactly, the transplanted material helps is currently unknown. It could be that the newly introduced bacteria outcompete the C. difficile organisms, or it could be that bacterial by-products in the stool help restore balance to the gut. Other researchers are looking at its potential role in autoimmune diseases, senile dementia, IBD and complex inflammation driven illnesses.
“It’s an inelegant procedure with an elegant outcome.”
 John M. Eisenberg Center for Clinical Decisions and Communications Science. Clostridium difficile Infections: Diagnosis, Treatment, and Prevention. Comparative Effectiveness Review Summary Guides for Clinicians [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2007-. 2011 Dec 19.View Full Paper
 Kassam Z, Hundal R, Marshall JK, Lee CH. Fecal Transplant via Retention Enema for Refractory or Recurrent Clostridium difficile Infection. Arch Intern Med. 2012 Jan 23;172(2):191-3 No Abstract Available
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