Fecal Transplants: Brother, Can You Spare a Stool Sample?


Clostridium difficile is a nasty little bacterium that causes a range of gastro-intestinal symptoms that, depending on the patient, can be treated with some difficulty or can result in death.

The scary part is how often and how commonly this bacterium is contracted by patients at the hospital. It is one of the most common hospital-acquired infections.

Consumer Reports

According to Consumer Reports, about 1.7 million people go to US hospitals each year and as many as 100,000 come out in a body bag thanks to an infection they picked up while there.

Too often this infection is C. difficile.

High Risk Patients

Some patients considered to be at high risk of being infected with C. difficile are blood cancer patients undergoing stem cell transplants because they undergo aggressive chemotherapy, must endure a lengthy hospital stay, and they are immunosuppressed for an extended period of time— making for an easily infected patient.

When cancer patients do get C. difficile during their hospital stay, the result is often what's known as Clostridium difficile–associated diarrhea (CDAD). At least 15% of CDAD patients infected in the hospital are cancer patients, and this symptom boosts the mortality rate among these patients.

The Euphemism to Beat All Euphemisms

The antiobiotic fidaxomicin and the recently approved fidaxomicin can treat CDAD in patients, but they don't have the success rates that doctors would ideally like to see. Enter the intestinal microbiota transplant, or IMT.

What's an intestinal microbiota transplant?

An intestinal microbiota transplant, also called a fecal transplant, is a procedure in which some fecal material--yes, poop--is collected from one of your healthy family members. It is tested for diseases, including hepatitis, HIV and even C. difficile. And once given the all-clear, doctors take 30-50 grams of it, stir it up with some warm water, filter it through a gauze, and then the patient drinks it.

I'm kidding, the patient doesn't drink it. It's administered either via colonoscopy or via naso-gastric tube (that's exactly what it sounds like it is).

The amazing thing is that it appears to work.

A new study presented at IDWeek 2012 by Mayur Ramesh, MD, of Henry Ford Hospital in Detroit and colleagues demonstrated some impressive results from IMT in patients with the infection. Out of 49 patients who underwent the procedure, symptoms vanished in 46 of them within no more than four days—with no adverse effects.

"This treatment is a viable option for patients who are not responding to conventional treatment and who want to avoid surgery," said Dr. Ramesh.

Keep in mind that these findings have been reported at a medical conference and have yet to be peer-reviewed, but they are supported by previous studies that have reached the same conclusion: IMT is a very effective means of dealing with an otherwise complicated and difficult infection.

"Brother, can you spare a ..."

Of course, doctors and hospital staff should be working just as hard—strike that, they should be working much harder—at maintaining sterile environments at the hospitals in order to avoid this infection in the first place.

Patients too can do their part. One way is to follow the checklist created by Dr. Peter Provonost, which can be found here. Going to the hospital can be bad enough. It shouldn't make you even more sick than you should be.

But if it does, you may find yourself facing that awkward moment where you have to ask a family member—not for money or a kidney—but for a stool sample.

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