Fecal Transplant for Treatment of Clostridium Difficile Infection

Clostridium difficile is a bacterium known to cause a diarrheal illness that can sometimes be serious or life-threatening. Patients are at risk of developing C. difficile if they have recently been on antibiotics, been hospitalized, or visited a physician’s office, or if they have decreased immune function. Typical symptoms include watery diarrhea, abdominal pain, abdominal distention, and fevers. In severe cases, patients may develop a complication called toxic megacolon and may require colectomy (removal of their colon). If the illness becomes this severe, there is a high mortality rate.

We believe that one of the main risk factors for the illness is a change in the normal bacteria that live in the GI tract. When normal bacteria is disturbed by antibiotics given for another infection, it allows the C. difficile bacteria to proliferate.

Typical first and second line treatments for C. difficile are the antibiotics Flagyl (metronidazole) and Vancocin (vancomycin).

Some patients may either not respond to these medications, or have a recurrence of symptoms after they have improved. These patients may be classified as refractory patients (never got better) or recurrent patients (those that improved but then had symptoms again). With each recurrence of C. difficile, the likelihood of completely treating it is smaller. But, patients that fall into this category may be candidates for a treatment called fecal transplant.

Fecal transplant (also known as stool transplant, fecal microbiota transplant, or FMT) is a technique that aims to treat C. difficile infection by restoring normal gut bacteria to the affected patient’s GI tract. The success rate of this procedure is remarkable: over 90% in most studies. The Food and Drug Administration regards this treatment as investigational, though there are increasing numbers of centers around the country that are performing it.

There are numerous research studies around the country that are investigating the utility of fecal transplant for a variety of conditions, including irritable bowel syndrome and inflammatory bowel disease. There have been some interesting and compelling initial data. These conditions, however, can only be treated by fecal transplant in the setting of a research study. We cannot currently treat these conditions with fecal transplant at Temple University Hospital. The only indication for which fecal transplant is an option at Temple is C. difficile infection.

A patient may first see me in the office to discuss his or her history of C. difficile, prior treatments, other medical conditions, and the risks and benefits of the treatment. If the patient is deemed to be a suitable candidate, the procedure is scheduled.

Donor stool is obtained from a stool bank. At this facility, donors and their stool are tested in a similar manner to blood donation. They are screened for infectious agents such as HIV and Hepatitis C. The stool bank processes the stool and provides it to Temple frozen and ready for use.

Fecal transplant is performed by colonoscopy. Patients prepare for the procedure in a similar way as they would for a colonoscopy as well - by having only clear liquids on the day prior to the procedure and drinking a laxative preparation. During the colonoscopy, the donor stool is infused into the GI tract.

After the procedure, patients remain lying down for one hour. Patients may be given an anti-diarrheal agent to help retain the donor stool for longer. After this observational hour, patients are discharged home. Although response times vary, typically patients start to improve within one to three days. We ask patients to return for a follow-up appointment one month later.

There are numerous research studies around the country that are investigating the utility of fecal transplant for a variety of conditions, including irritable bowel syndrome and inflammatory bowel disease. There have been some interesting and compelling initial data. These conditions, however, can only be treated by fecal transplant in the setting of a research study. We cannot currently treat these conditions with fecal transplant at Temple University Hospital. The only indication for which fecal transplant is an option at Temple is C. difficile infection.