Fighting Bacterial Infection with Bacteria: Fecal Transplant

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Fighting a bacterial infection with a healthy strain of bacteria through fecal transplant from a healthy person may sound outrageous to some, but according to some physicians, fecal transplant treatment can be surprisingly effective. According to a recent review by the medical journal Clinical Infectious Diseases, 92% of patients infected with a harmful gut bacterium were successfully cured following a fecal transplant.

A recent national news story about Pat Shoop, a 75 year-old woman married 52 years to her husband Bob, brings to light the idea of replacing harmful gut bacteria with healthy bacteria from another individual’s fecal matter to cure some gastrointestinal diseases.
Mrs. Shoop was diagnosed with a Clostridium difficile infection in her intestinal tract that caused her to suffer from flu-like symptoms including severe diarrhea, abdominal pain, nausea and vomiting. National news sources report her saying that, “I was so sick, I didn’t care," she recalled. "It feels like the worst case of flu you could possibly, possibly have.”

Clostridium difficile is a long-lasting, toxic and sometimes fatal bacterium that patients typically pick up while staying at a hospital. Clostridium difficile spores can live outside the body for long periods of times on the surfaces of bathroom fixtures, hospital beds, bed rails and linens and medical equipment. Mrs. Shoop attributes her infection to either a temporary stay at a nursing home for a broken arm or in a hospital for breast cancer treatment.

The rate of hospital infection by Clostridium difficile has climbed steadily the past several years. According to a 2009 study reported by the Centers for Disease Control (CDC), hospitals and nursing homes in the state of Ohio reported 18,200 cases of Clostridium difficile infection (CDI), which included 7,000 hospital cases and 11,200 nursing homes cases during a 12-month period in 2006.

The CDC states that 20 percent to 50 percent of those patients may wind up with hard-to-treat recurrent infections. Antibiotic therapy may be used to treat Clostridium difficile in some severe cases, but it is not always successful. In other cases a person may have to have surgery to remove the infected part of the intestines. Surgery is reportedly required in approximately 1 to 2 out of every 100 persons infected with Clostridium difficile.

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The idea of fecal transplant to treat intestinal infections originates reportedly to a practice several centuries ago where farmers would treat livestock for indigestion by feeding them with bacteria-containing stomach fluid from a healthy farm animal.

Last year, Thomas Borody, an Australian gastroenterologist is reported to recall having performed his first fecal transplant in the mid-80’s to cure a patient who had developed an incurable colitis after vacationing in Fiji. Dr. Borody found a paper published in 1958 that described successful treatment of four similar cases of patients with inflamed digestive systems who were cured by infusing the fecal matter of a healthy individual into the digestive tract of the ill patients.

The published paper inspired him to try it out on his patient by collecting a stool sample from the patient’s brother, grinding it in a blender with some brine, filtering out the solid matter and then delivering the solution via multiple enemas into his patient. The result was apparent within a few days as the colitis disappeared and never returned.

In Mrs. Shoop’s case, the treatment was a stool sample from her husband that was processed by clinical staff at Essentia Health in Duluth, Minnesota and then administered by Dr. Tim Rubin, a gastroenterologist whose team has performed its 119th fecal transplant last week. Mrs. Shoop’s husband’s processed stool sample was fed into her stomach via a tube through her nose. Three days later Mrs. Shoop was feeling better and now a year later is completely recovered of the Clostridium difficile infection with her husband’s healthy bacteria having replaced her harmful gut bacteria.

A review published in this year’s November issue of the medical journal Clinical Infectious Diseases, reports that the use of fecal transplant as a way to treat bacterial infection with Clostridium difficile is highly effective, after reviewing the medical records of 317 patients showing disease resolution in 92% of the cases. They recommend that physicians use their review as a guideline for future treatment until more definitive studies further confirming that fecal transplant treatment is a sound and safe medical practice.

Currently, research is ongoing toward the possible application of fecal transplant in treating patients with metabolic disease and obesity.

Source: “Systematic Review of Intestinal Microbiota Transplantation (Fecal Bacteriotherapy) for Recurrent Clostridium difficile Infection” Clin. Infect Dis. (2011) 53 (10): 994-1002. doi: 10.1093/cid/cir632

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