Clostridium difficile – a hospital superbug?
Clostridium difficile is a bacterium that is commonly found in the environment around us – in soil, air and water. C. difficile is also present in the gut of up to 3% of healthy adults and 66% of infants, but rarely causes any problems in healthy people. This is because it is usually kept in line by the normal bacterial population in the intestine. However, when people undergo antibiotic treatment, this can disrupt the balance of bacteria in the gut, allowing C. difficile to rapidly multiply and cause illness. C. difficile infection (CDI) can result in very mild diarrhoea, but can also result in some particularly nasty, life threatening symptoms, that in the extreme can lead to someone having their colon surgically removed.
CDI is the leading cause of infectious diarrhoea in healthcare institutions worldwide, and the problem doesn’t seem to be going away anytime soon. In fact, over the last decade CDI has become more frequent, more difficult to get rid of fully and more often actually causes death. This is thought to be due to the emergence of more aggressive C. difficile strains.
CDI is commonly treated with antibiotic therapy, but this is by no means the perfect treatment option as it is becoming increasingly associated with treatment failure and return of infection. In addition, CDI weighs a heavy financial burden on healthcare systems across the world, each case costing approximately £4000. This particular conundrum has led to a race in the development of alternative treatment therapies for the disease and has recently reignited the interest in an age old therapy: the faecal transplant.
What is a faecal transplant?
The faecal transplant has been knocking around for centuries, with its first use to treat diarrhoea being described all the way back in 4th century China. Possibly one of the reasons it hasn’t proved so popular is due to the fact that it sounds so disgusting. The faecal transplant involves the transfer of poop from a healthy individual to the gut of a patient to cure their disease. Obviously, there is only one of two routes to administer this lovely load; via a nose tube directly into the stomach (apparently rather unpleasant when the patient burps) or through colonoscopy. I think we can all agree that neither of these options seems at all appealing, but treating patients with CDI with faecal transplants does seem to work.
Indeed, clinical trials suggest that the faecal transplants are both well tolerated and very effective. In the most recent study carried out in the Netherlands, published in the New England Journal of Medicine earlier this year, it was found that that faecal transplants cured 15 out of 16 patients with recurring CDI – a 96% success rate compared to less than 30% for standard antibiotic therapy.
So, what is the science behind a faecal transplant and why does it work?
It is estimated that over 4000 bacterial species reside in the gastrointestinal tract, and amazingly, we are inherently outnumbered by the number of bacteria that live in our body. The human microbiota contains as many as 100 trillion bacteria, which is ten times greater than the number of human cells in our body. Not to worry though folks, these bacteria are friends, not foes.
In fact, it has become very apparent in recent years that friendly bacteria residing in the gut do their bit to keep us healthy. A number of diseases, including cancer, inflammatory bowel disease and arthritis, are linked with changes in the make-up of the types of gut bacteria. With respect to C. difficile infection, the disease most commonly arises in patients who have undergone antibiotic therapy, which results in the disruption of their normal intestinal microbiota. Antibiotics can wipe out the good bacteria in the gut that usually provide a protective defence against C. difficile, allowing it to flourish and cause infection.
With this in mind, a faecal transplant doesn’t seem so daft. Transferring poop from a healthy donor to the gut of a patient with CDI is thought to restore the good bacteria for them to help fight C. difficile, preventing any further disease.
Can we get past the yuck factor?
We know that the results from clinical trials suggest that the faecal transplant not only works, but is well tolerated: the two gold stars with respect to disease therapy. But the fact remains that the faecal transplant is also, quite frankly, gross. People often don’t like the thought of taking others seconds or leftovers – is this treatment taking it one step too far?
Testimonials from patients treated with the faecal transplant suggest quite the opposite; these patients have won their battle with CDI and changed their life thanks to the unusual therapy. They are all more than happy to recommend it to others.
Yes, we know that the faecal transplant is not pretty, but neither is the possibility of major surgery leaving us with a stoma bag because all other treatment has failed.
Which option would you choose?