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Little-known fecal transplant cures woman's bacterial infection
Little-known fecal transplant cures woman's bacterial infection
By William Hudson, CNN
updated 5:05 PM EDT, Wed September 26, 2012
(CNN) -- After surviving a near-fatal car accident, Kaitlin Hunter found herself battling a devastating bacterial infection in her colon that also threatened her life.
The persistent infection was beaten through a little-known technique involving the transplant of fecal matter from Hunter's mother, which put healthy bacteria back into her colon.
Following the July procedure, "I've been so happy," said Hunter, 20, of Marietta, Georgia. "I'm cured."
Her struggle began more than a year earlier when she was released from a hospital in Sacramento, California.
A June 2011 car accident fractured her lower spine, lacerated her liver and colon, and broke all 10 toes. Emergency crews used the Jaws of Life to cut Hunter from her dad's car, and then she was flown to the hospital, where she spent the next month.
Upon her release, Hunter flew home to Georgia. It hadn't been the summer vacation she imagined, but she thought she was getting better.
But "right when I got off the plane, I went to the hospital. I was having extremely bad stomach pain. A month later, we found out it was C. diff," Hunter said, using the abbreviation for the bacteria clostridium difficile.
How it began
In the hospital after her accident, doctors followed standard care and put Hunter on antibiotics to prevent an infection.
In spite of the antibiotics -- or possibly because of them -- C. diff infected her colon, causing severe stomach pain, diarrhea and vomiting.
Hunter, who stands 5 feet 7 inches tall, lost 40 pounds during her struggle. Her weight plummeted to 85 pounds.
It's believed that antibiotics, which kill harmful infection-causing bacteria, also weaken the beneficial, healthy bacteria percolating in the colon. With the colon's defenses down, C. diff grows rampant, releasing a toxin and inflaming the colon.
C. diff infections kill about 14,000 people in the United States every year, according to the Centers for Disease Control and Prevention, and the number and severity of total cases have increased dramatically over the past decade.
Even though antibiotics put someone at risk of developing a C. diff infection, standard treatment still calls for prescribing more and different antibiotics to kill the C. diff and allow healthy bacteria to recolonize.
But for many people such as Hunter -- who went through nine rounds of antibiotic treatments -- the healthy bacteria never get the upper hand, and the C. diff just keeps coming back.
'Brand-new' treatment
Increasingly, doctors are taking a different approach. Instead of continued assaults on bacteria, "fecal matter transplants" recolonize the colon with new bacteria from a healthy donor.
"This is brand-new for most gastroenterologists," said Dr. Suku George, Hunter's treating physician. "We are very excited about this."
George had never deposited fecal matter by colonoscopy into a patient until Hunter wanted to try it.
Hunter's mother "donated" one of her stools for the procedure. Next, the hospital lab carefully diluted it, and George pumped the foreign fecal matter right into Hunter's colon.
The result ended Hunter's struggle with C. diff.
A study published in March reported a 91% cure rate after just one fecal matter transplant, and a 98% cure rate when combined with an additional round of antibiotics.
Remarkably, that study only included the sickest of patients. All 77 of the study participants already had a recurring C. diff infection, having tried and failed five rounds of antibiotic-only treatments over 11 months, on average.
The study used the colonoscopy method, which many believe is the most effective, because relatively large amounts of fecal matter can be placed deep inside the colon.
Other methods use either an enema or a nasogastric tube, which sends fecal matter through the nasal passage, down the throat and into the stomach.
George tried the nasogastric tube on Hunter, using fecal material from her father, but the C. diff infection returned. He then asked for and received permission to perform the hospital's first colonoscopic fecal transplant.
Looking ahead
Gastroenterologists pioneering the practice unanimously seem to agree that eventually a cleaner, commercially developed suppository will replace the crude feces and water mixtures currently in use.
"It'll become a little more acceptable to hospitals and patients and more widely performed," said Dr. Lawrence Brandt, a professor of medicine and surgery at New York's Albert Einstein College of Medicine who was the lead author on the March study. "But for people that have recurring C. diff, it doesn't really much matter, because these patients are so ill and so much want to get better. The fact that it's stool, it doesn't matter to them."
To enroll in a fecal transplant study, visit clinicaltrials.gov.
See: http://www.cnn.com/2012/09/26/health/fecal-transplant/index.html?hpt=hp_t3
By William Hudson, CNN
updated 5:05 PM EDT, Wed September 26, 2012
(CNN) -- After surviving a near-fatal car accident, Kaitlin Hunter found herself battling a devastating bacterial infection in her colon that also threatened her life.
The persistent infection was beaten through a little-known technique involving the transplant of fecal matter from Hunter's mother, which put healthy bacteria back into her colon.
Following the July procedure, "I've been so happy," said Hunter, 20, of Marietta, Georgia. "I'm cured."
Her struggle began more than a year earlier when she was released from a hospital in Sacramento, California.
A June 2011 car accident fractured her lower spine, lacerated her liver and colon, and broke all 10 toes. Emergency crews used the Jaws of Life to cut Hunter from her dad's car, and then she was flown to the hospital, where she spent the next month.
Upon her release, Hunter flew home to Georgia. It hadn't been the summer vacation she imagined, but she thought she was getting better.
But "right when I got off the plane, I went to the hospital. I was having extremely bad stomach pain. A month later, we found out it was C. diff," Hunter said, using the abbreviation for the bacteria clostridium difficile.
How it began
In the hospital after her accident, doctors followed standard care and put Hunter on antibiotics to prevent an infection.
In spite of the antibiotics -- or possibly because of them -- C. diff infected her colon, causing severe stomach pain, diarrhea and vomiting.
Hunter, who stands 5 feet 7 inches tall, lost 40 pounds during her struggle. Her weight plummeted to 85 pounds.
It's believed that antibiotics, which kill harmful infection-causing bacteria, also weaken the beneficial, healthy bacteria percolating in the colon. With the colon's defenses down, C. diff grows rampant, releasing a toxin and inflaming the colon.
C. diff infections kill about 14,000 people in the United States every year, according to the Centers for Disease Control and Prevention, and the number and severity of total cases have increased dramatically over the past decade.
Even though antibiotics put someone at risk of developing a C. diff infection, standard treatment still calls for prescribing more and different antibiotics to kill the C. diff and allow healthy bacteria to recolonize.
But for many people such as Hunter -- who went through nine rounds of antibiotic treatments -- the healthy bacteria never get the upper hand, and the C. diff just keeps coming back.
'Brand-new' treatment
Increasingly, doctors are taking a different approach. Instead of continued assaults on bacteria, "fecal matter transplants" recolonize the colon with new bacteria from a healthy donor.
"This is brand-new for most gastroenterologists," said Dr. Suku George, Hunter's treating physician. "We are very excited about this."
George had never deposited fecal matter by colonoscopy into a patient until Hunter wanted to try it.
Hunter's mother "donated" one of her stools for the procedure. Next, the hospital lab carefully diluted it, and George pumped the foreign fecal matter right into Hunter's colon.
The result ended Hunter's struggle with C. diff.
A study published in March reported a 91% cure rate after just one fecal matter transplant, and a 98% cure rate when combined with an additional round of antibiotics.
Remarkably, that study only included the sickest of patients. All 77 of the study participants already had a recurring C. diff infection, having tried and failed five rounds of antibiotic-only treatments over 11 months, on average.
The study used the colonoscopy method, which many believe is the most effective, because relatively large amounts of fecal matter can be placed deep inside the colon.
Other methods use either an enema or a nasogastric tube, which sends fecal matter through the nasal passage, down the throat and into the stomach.
George tried the nasogastric tube on Hunter, using fecal material from her father, but the C. diff infection returned. He then asked for and received permission to perform the hospital's first colonoscopic fecal transplant.
Looking ahead
Gastroenterologists pioneering the practice unanimously seem to agree that eventually a cleaner, commercially developed suppository will replace the crude feces and water mixtures currently in use.
"It'll become a little more acceptable to hospitals and patients and more widely performed," said Dr. Lawrence Brandt, a professor of medicine and surgery at New York's Albert Einstein College of Medicine who was the lead author on the March study. "But for people that have recurring C. diff, it doesn't really much matter, because these patients are so ill and so much want to get better. The fact that it's stool, it doesn't matter to them."
To enroll in a fecal transplant study, visit clinicaltrials.gov.
See: http://www.cnn.com/2012/09/26/health/fecal-transplant/index.html?hpt=hp_t3
Well with this success story, hopefully they'll come around and see that it IS a good thing.
I read with interest that doctors are reluctant to use this procedure in large part because they feel their patients wouldn't want it. BUT, the patients DO want it.
"... It has been suggested that perhaps it is clinicians rather than patients who are resistant to the use of FMT as a viable treatment option.[49] In a survey of 73 physicians, 25 (34%) indicated they would be unwilling to perform the procedure with the most common concerns being patient acceptance and tolerability (71%) followed by safety (60%) and efficacy (57%).[50] In contrast, in a recent qualitative study exploring readiness for FMT in patients with UC, the majority of patients wished the procedure was already available and most viewed it as being safer than current available therapies, especially steroids or biological therapies...."
"... It has been suggested that perhaps it is clinicians rather than patients who are resistant to the use of FMT as a viable treatment option.[49] In a survey of 73 physicians, 25 (34%) indicated they would be unwilling to perform the procedure with the most common concerns being patient acceptance and tolerability (71%) followed by safety (60%) and efficacy (57%).[50] In contrast, in a recent qualitative study exploring readiness for FMT in patients with UC, the majority of patients wished the procedure was already available and most viewed it as being safer than current available therapies, especially steroids or biological therapies...."
Thank god for Dr's...For real!
I joked about this, but I have to say, if I was approached tomorrow and told that a poop transplant would cure my renal issues, I'd jump on board in a freaking NANO-SECOND.
Systematic Review: Faecal Microbiota Transplantation in the Management of Inflammatory Bowel Disease
J. L. Anderson; R. J. Edney; K. Whelan
Posted: 09/11/2012
"......The greatest body of evidence for the efficacy of fecal microbiota transplantation (FMT) is in the treatment of recurrent C. difficile infection. A recent systematic review of FMT for the treatment of recurrent C. difficile infection and pseudomembranous colitis in general patients showed a 92% resolution in 317 patients across 27 case series and case reports.[13] Another systematic review showed 83% of 124 patients with C. difficile-associated disease with improved symptoms.[17] However, this is the first ever systematic review to investigate the role of FMT in the context of IBD.
Searches of clinical trial databases indicate at least five trials of FMT in progress, three of which are in patients with IBD. One is investigating the microbiological, immunological and clinical sequelae of FMT in the treatment of chronic pouchitis. Another is a RCT of FMT for the induction of endoscopic and clinical remission of active UC and there is also a pilot study of the effect of FMT on clinical symptoms of paediatric patients with UC or colonic CD. In addition, two trials are in the treatment of infectious diarrhoea, comparing FMT with vancomycin. These trials will provide much needed high-grade evidence for the efficacy of FMT in inflammatory bowel disease (IBD) and in C. difficile infection.
Barriers to the adoption of FMT as a therapeutic tool include the absence of high-quality evidence for its efficacy, patient and clinician acceptance and potential safety concerns. It has been suggested that perhaps it is clinicians rather than patients who are resistant to the use of FMT as a viable treatment option.[49] In a survey of 73 physicians, 25 (34%) indicated they would be unwilling to perform the procedure with the most common concerns being patient acceptance and tolerability (71%) followed by safety (60%) and efficacy (57%).[50] In contrast, in a recent qualitative study exploring readiness for FMT in patients with UC, the majority of patients wished the procedure was already available and most viewed it as being safer than current available therapies, especially steroids or biological therapies.[51] In a quantitative extension of this study, the majority of UC patients were interested or willing to consider FMT despite reporting disease control with IBD medications.[52] The most important concerns were around donor selection and screening as a means of eliminating the potential risk of transmission of infectious agents. This risk can be reduced with the implementation of thorough screening protocols. Interestingly, this systematic review highlights that close relatives are frequently selected as stool donors. However, recent evidence indicates that the relatives of patients with IBD themselves have altered microbiota,[53] and that this dysbiosis may itself be partly responsible for their elevated risk of IBD.[54] Investigation of the ideal stool donor in FMT in the context of IBD is warranted....."
http://www.medscape.com/viewarticle/770009
J. L. Anderson; R. J. Edney; K. Whelan
Posted: 09/11/2012
"......The greatest body of evidence for the efficacy of fecal microbiota transplantation (FMT) is in the treatment of recurrent C. difficile infection. A recent systematic review of FMT for the treatment of recurrent C. difficile infection and pseudomembranous colitis in general patients showed a 92% resolution in 317 patients across 27 case series and case reports.[13] Another systematic review showed 83% of 124 patients with C. difficile-associated disease with improved symptoms.[17] However, this is the first ever systematic review to investigate the role of FMT in the context of IBD.
Searches of clinical trial databases indicate at least five trials of FMT in progress, three of which are in patients with IBD. One is investigating the microbiological, immunological and clinical sequelae of FMT in the treatment of chronic pouchitis. Another is a RCT of FMT for the induction of endoscopic and clinical remission of active UC and there is also a pilot study of the effect of FMT on clinical symptoms of paediatric patients with UC or colonic CD. In addition, two trials are in the treatment of infectious diarrhoea, comparing FMT with vancomycin. These trials will provide much needed high-grade evidence for the efficacy of FMT in inflammatory bowel disease (IBD) and in C. difficile infection.
Barriers to the adoption of FMT as a therapeutic tool include the absence of high-quality evidence for its efficacy, patient and clinician acceptance and potential safety concerns. It has been suggested that perhaps it is clinicians rather than patients who are resistant to the use of FMT as a viable treatment option.[49] In a survey of 73 physicians, 25 (34%) indicated they would be unwilling to perform the procedure with the most common concerns being patient acceptance and tolerability (71%) followed by safety (60%) and efficacy (57%).[50] In contrast, in a recent qualitative study exploring readiness for FMT in patients with UC, the majority of patients wished the procedure was already available and most viewed it as being safer than current available therapies, especially steroids or biological therapies.[51] In a quantitative extension of this study, the majority of UC patients were interested or willing to consider FMT despite reporting disease control with IBD medications.[52] The most important concerns were around donor selection and screening as a means of eliminating the potential risk of transmission of infectious agents. This risk can be reduced with the implementation of thorough screening protocols. Interestingly, this systematic review highlights that close relatives are frequently selected as stool donors. However, recent evidence indicates that the relatives of patients with IBD themselves have altered microbiota,[53] and that this dysbiosis may itself be partly responsible for their elevated risk of IBD.[54] Investigation of the ideal stool donor in FMT in the context of IBD is warranted....."
http://www.medscape.com/viewarticle/770009
I think I'm going to start collecting my poop, then posting on Ebay & Craigslist , then sell to the highest bidder.
I'm a freaking GEE-NEE-USS!!!
It's a wonder someone hasn't already beaten me to punch on this.
I'm a freaking GEE-NEE-USS!!!
It's a wonder someone hasn't already beaten me to punch on this.
Wow ! that's quite a story.
I guess whatever works. . .
I guess whatever works. . .
BTW, a fecal transplant is a lot less messy than the symptoms of C diff.
I am close to someone that had C diff and it almost killed him. Honestly, a remedy for that is awesome.
And to tell you the truth, I've been concerned in the past few years that the medical researchers were losing the ability to come up with novel approaches to treating things.
I'm glad to see this kind of research and that it has a good result. thanks for sharing mikesimon!
And to tell you the truth, I've been concerned in the past few years that the medical researchers were losing the ability to come up with novel approaches to treating things.
I'm glad to see this kind of research and that it has a good result. thanks for sharing mikesimon!
I do realize the seriousness of this ordeal, though. It's just kind of hard to get past having someone else's poop get pumped into another person's body. I've had my fair share of colon problems, colonoscopies, sigmoidoscopies, and a barium enema. So yes, definitely a messy job (especially the prep!) that I can only imagine how unpleasant it could be even though it's to save a life.
Welllll...the alternative is to get someone else's poop through your nose and into your stomach, so...
"Uhhh... Hi, Mom? Can you come over and poop in my butthole for me? Thanks Mom. You're a lifesaver!"
True that.
Everyone thinks it's funny now but g-d forbid one of us comes down with C diff - we'll be asking our family and friends to queue up in the donor line.
This study is full of...it. ;-)
Its a messy job, but somebody's got to pooh it...
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