Fecal Transplantation Effective for Resistant C. Difficile Infection

Recurrent clostridium difficile (CD) infection is becoming a growing problem globally because it has been associated with significant morbidity, mortality, and increased economic burden. The infection is associated with a relapse rate of approximately 25%.5 In addition, the chances of recurrence grow with each recurrent episode. According to Lawrence Brandt, MD, of Albert Einstein College of Medicine and Montefiore Medical Center in Bronx, New York, “The chances of a second recurrence in patients who experienced one recurrence is approximately 35%, with the risk increasing up to 45% or even 65% for a third recurrence after treatment of a second recurrence. The chance of having yet another recurrence after a third recurrence is overwhelming.”

Although physicians can manipulate antibiotic drug regimens, some patients remain refractory. More recently, fecal microbiota transplantation (FMT) has been utilized for the treatment of recurrent CD. FMT is the placement of stool obtained from a healthy donor into the gastrointestinal tract of a patient with a specific disease, such as CD infection, to correct an imbalance or dysbiosis in the microorganisms residing in the patient’s intestinal tract, thereby attempting to cure the specific disease.


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A recent review article discusses evidence demonstrating the efficacy of using FMT in patients with recurrent CD.5 “The advantages of fecal transplantation is that it works for patients with multiple CD recurrences. There are Infectious Disease specialists that have had success using different combinations of antibiotics and tapering antibiotics to treat patients with recurrent CD infection. However, many physicians don’t necessarily have that expertise and understand how to appropriately monitor patients, so they find fecal transplant relatively efficient,” said Vincent Young, MD, PhD, review author and associate professor at the University of Michigan in Ann Arbor.

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While FMT is clearly effective for the treatment of recurrent CD infection and relatively safe, the long-term risks remain unclear. “There have been very few short-term risks associated with FMT. Patients may develop cramps, bloating, and constipation. Other adverse effects include low-grade fever and disease exacerbation in cases of ulcerative colitis,” said Brandt. Young further explained, “If you are treating patients with FMT, there is the concern, admittedly hypothetical right now, that you are putting the recipient at higher risk for other diseases due to changes in microbiota, and this is a big unknown.”

Conclusion

Overall, new antibiotic targets, utilization of other classes of drugs with antibiotic properties, and new approaches such as FMT may help to alleviate the burden of antibiotic resistance.

References:

  1. World Health Organization. Antimicrobial resistance. Available at: http://www.who.int/mediacentre/factsheets/fs194/en/. Accessed: April 8, 2014.
  2. Centers for Disease Control (CDC). Antibiotic resistance threats in the United States, 2013. Available at: http://www.cdc.gov/drugresistance/threat-report-2013/pdf/ar-threats-2013-508.pdf . Accessed: April 8, 2014.
  3. Yin Z, Wang Y, Whittell L, et al. DNA Replication is the target for the antibacterial effects of nonsteroidial anti-inflammatory drugs. Chemistry & Biology. 2014; 21: 1-7.
  4. Kozarov E, Padro T, and Badimon, L. View of statins as antimicrobials in cardiovascular risk modification. Cardiovascular Research. 2014; 1-13.
  5. Koenigsknecht M, Young V. Faecal microbiota transplantation for the treatment of recurrent Clostridium difficile infection: current promise and future needs. Current Opinion in Gastroenterology. 2013; 29 (6); 628-629.