Fecal transplantation as a treatment for C. difficile?

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[cs_content][cs_section parallax=”false” style=”margin: 0px;padding: 45px 0px;”][cs_row inner_container=”true” marginless_columns=”false” style=”margin: 0px auto;padding: 0px;”][cs_column fade=”false” fade_animation=”in” fade_animation_offset=”45px” fade_duration=”750″ type=”2/3″ style=”padding: 0px;”][cs_text]A fecal transplant, otherwise known as a Fecal Microbiota Transplant, involves the transfer of a stool from a healthy donor into a patient’s gastrointestinal tract.

The procedure is becoming more commonly used for helping to prevent the recurrence of Clostridium difficile, otherwise known as C. difficile.

This is because the donated stool can help replace good bacteria that has been wiped out or suppressed by the use of antibiotics, which are typically used as a first-line treatment for C.difficile.

This is important because if good bacteria are destroyed and bad bacteria are allowed to thrive, the living organisms in the intestine will not be able to prevent C. difficile once more becoming a dominant organism in the environment of the gut.

What is C. diff?

According to the National Institute for Health & Care Excellence (NICE), C. diff bacterium lives harmlessly in the gut of approximately 5% of healthy people.

However, the use of certain antibiotics and immunosuppressive agents can change the balance of bacterial species in the gut and cause C. difficile to overpopulate the colon.

Whilst a healthy level of C. diff bacteria is harmless, higher levels can cause illness, with mild infections causing problems such as diarrhoea and abdominal cramps and more severe cases capable of causing bloody diarrhoea, fever and even death.

As such, it is hugely important to make use of an effective treatment to rebalance the microflora in the gut; something which can be effectively achieved through fecal transplantation.

How is the transplant carried out?

Before the transplant can take place a donor must be found that can provide a suitable stool. The donors can be family members but do not need to be related, as this does not make for a more successful outcome.

What is important is that the donor is found to meet specific criteria to ensure minimum risk of infecting the patient with other illnesses. For this reason, donors are carefully screened to ensure they will not pass on enteric bacterial pathogens, viruses and parasites.

Once a suitable donor is found, NICE guidance says that their faeces should be taken and “diluted with water, saline or another liquid such as milk or yogurt, and subsequently strained to remove large particles. The resulting suspension is introduced into the recipient’s gut via a nasogastric tube, nasoduodenal tube, rectal enema or via the biopsy channel of a colonoscope.

Recipients may receive a bowel lavage before transplantation, in order to reduce the C. difficile load in the intestines.”

How effective is fecal transplantation for C.diff?

A number of studies have shown a markedly high success rate when patients have undergone a fecal transplant to treat C. diff, as opposed to when they have been treated with an antibiotic, such as vancomycin.

For example, according to NICE, a trial of 43 people treated by faecal transplant versus vancomycin with a bowel lavage versus vancomycin only, reported a primary cure rate of 81% (13/16), 23% (3/13) and 31% (4/13) respectively at 10-week follow-up.

Tackling C. difficile in your care home

With its high rate of recurrence, C. difficile can be a major problem for care homes, however with the right infection control measures an outbreak can be contained. Click here to download our step-by-step action plan to help with a C. diff outbreak.

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