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Hospital infection can be treated with transplanted faeces

By Grant Stewart

As treatments go, it sounds pretty unpleasant. But research shows that using transplanted faeces (poo, in other words) from someone else can work to treat a severe type of diarrhoea.

What do we know already?

Clostridium difficile (C difficile) is a bacteria that causes severe diarrhoea. We all have bacteria in our bodies all of the time. Most of them are there for good reasons: for example, helping break down the food in our digestive systems. You may have heard these called ‘good’ bacteria. But the wrong types of bacteria can cause infection and illness.

Bacterial infections are usually treated with antibiotics. C difficile is hard to treat, though, because the usual antibiotics often don’t work. In fact, most C difficile infections result from people taking antibiotics while in hospital to treat or prevent an infection. How do antibiotics cause an infection? When antibiotics kill off the ‘good’ bacteria in our guts, germs like C difficile, which have survived the antibiotics, can move in and take over the digestive system. When the normal healthy balance of different types of gut bacteria is disturbed in this way, the result can be severe diarrhoea, fever, and other symptoms of infection.

Previous studies have shown that faecal transplant, as this technique is called, works well in curing C difficile in the short term. But in the new study the researchers wanted to see how people did in the longer term. They wanted to know if the bacteria in their guts stayed in balance up to a year after treatment. The researchers looked at 14 people who’d had at least three bouts of C difficile in a short time, and who’d had at least three courses of antibiotics that hadn’t worked to cure the infection.

To treat the infection, samples of faeces were taken from 14 people who did not have C difficile. These samples were dissolved in water and then given to the people infected with C difficile at certain points along the bowel. This is done by inserting a tube in the rectum (back passage). An operation isn’t needed.

The researchers then tested samples of faeces from the people who'd had the treatments, at various points, for up to a year.

What does the new study say?

All 14 of the people in the study were cured of C difficile infection after two to three days. Samples of their faeces showed that the mix of bacteria was much more varied after treatment than before. This suggests that the transplanted faeces had helped replace the ‘good’ bacteria that had been killed by antibiotic treatment, and had restored a more healthy balance of bacteria in the gut.

The study also found that the treatment worked in the longer term - the varied mix of bacteria was still there when people were tested a year later.

How reliable is the research?

This was a well-conducted study with long follow-up and a 100 percent success rate. But it was also a small study. We need larger long-term studies of this treatment to be really sure how well it works.

What does this mean for me?

This must be one of the more unusual ways to treat an illness, and some people may find the idea too unpleasant to think about. But C difficile is a serious infection that can ruin lives. People suffering with this condition may not be fussy about what the cure involves.

If you are going into hospital and you want to know more about infections that can happen in hospital or from taking antibiotics, talk to your doctor.

Source:

Song Y, Garg S, Girotra M, et al. Microbiota dynamics in patients treated with fecal microbiota transplantation for recurrent Clostridium difficile infection. PLOS One. Published online 26 November 2013.

Nov 28, 2013