Clostridium difficile is a bacterium that can cause a severe, difficult to treat intestinal infection that can result in death. An international team of researchers conducted a study that evaluated the effectiveness of an infusion of feces into the intestinal tract of infected individuals. They published their findings online on January 16 in the New England Journal of Medicine.
The researchers noted that the infusion of feces from healthy donors has been reported as an effective treatment for recurrent C. difficile infection in more than 300 patients. The added, however, that experience with this procedure is limited by a lack of randomized trials supporting its efficacy and the unappealing nature of the treatment. In their new study, donor feces were infused in patients with recurrent C. difficile infection and compared with conventional 14-day vancomycin treatment, with and without bowel lavage (rinsing). Vancomycin is a potent antibiotic with significant side-effects, including kidney and hearing damage.
The investigators randomly assigned patients to receive one of three therapies: an initial vancomycin regimen (500 mg orally four times per day for 4 days), followed by bowel lavage and subsequent infusion of a solution of donor feces through a nasoduodenal tube (a tube that was fed through the nose down to the upper portion of the small intestine); a standard vancomycin regimen (500 mg orally four times per day for 14 days); or a standard vancomycin regimen with bowel lavage. The primary end point was the resolution of diarrhea associated with C. difficile infection without relapse after 10 weeks.
The study was terminated after an interim analysis. Of 16 patients in the infusion group, 13 (81%) had resolution of C. difficile–associated diarrhea after the first infusion. The three remaining patients received a second infusion with feces from a different donor, with resolution in two patients. Resolution of C. difficile infection occurred in four of 13 patients (31%) receiving vancomycin alone and in three of 13 patients (23%) receiving vancomycin with bowel lavage. No significant differences in adverse events among the three study groups were observed except for mild diarrhea and abdominal cramping in the infusion group on the infusion day. After donor-feces infusion, patients showed increased fecal bacterial diversity, similar to that in healthy donors, with an increase in Bacteroidetes species and clostridium clusters IV and XIVa and a decrease in Proteobacteria species.
The authors concluded that in patients with recurrent C. difficile infection, the infusion of donor feces, as compared with vancomycin therapy, resulted in better treatment outcomes. In particular, patients with multiple relapses of C. difficile infection benefited from this unconventional approach.
Take home message:
The intestinal tract harbors a multitude of organisms, many of which can be harmful if they overwhelm the harmless bacteria. C. difficile is one of them. A harmless bacterium that is found in the intestinal tract is Lactobacillus. That is why doctors often recommend yogurt, which contains lactobacilli, for patients who have been on antibiotics and develop bacteria. Lactobacilli can restore the balance between good and bad bacteria.