Drug resistant bacteria in the gut can be controlled using fecal transplant, say Mayo Clinic researchers
Transplanting human donor fecal microbiota into the colon of a patient infected with a drug resistant bacterium can be therapeutic.
According to an article in the Journal of the American Osteopathic Association a Clostridiodes difficile (C. diff) infection that does not respond to antibiotics, may be best treated by through fecal transplants. C. diff is the most common healthcare-acquired infection in the United States. It affects nearly half a million patients each year and becomes a recurring infection for nearly a third of them. If untreated, C. diff can lead to sepsis and death.
“Twenty five years ago C. diff infections were easier to manage and often resolved with discontinuation of the initiating antibiotic,” says Robert Orenstein, DO, an infectious disease specialist at Mayo Clinic and lead author on this article. “However, these infections have become increasingly common and pernicious.”
Unlike antibiotics, which are destructive by definition, fecal transplants or microbial replacement therapies, repopulate the gut with a diverse group of microbes that may block the C. diff‘s spore from germinating and propagating disease via its toxins
The standard and FDA-approved treatment for C. diff is a course of oral vancomycin, an antibiotic. However, even the medications used to eliminate C. diff can perpetuate the infection by killing off beneficial microbes. Newer antibiotics that more specifically target C. diff have been developed but they can be prohibitively expensive, according to Dr. Orenstein.
“Think of your gut as a forest and C. diff as a weed,” says Dr. Orenstein. “In a thriving forest, weeds barely get a foothold. But if you burn the forest down, the weeds are going to flourish.”
Unlike antibiotics, which are destructive by definition, fecal transplants or microbial replacement therapies, repopulate the gut with a diverse group of microbes that may block the C. diff‘s spore from germinating and propagating disease via its toxins. Transplants have several delivery methods, including enemas, capsules and direct instillation, to replace the diverse flora that maintain health and improve metabolism.
Currently, there are no FDA-approved fecal transplant products and performing fecal transplants is considered an investigational procedure. Dr. Orenstein notes there are several companies with products in Phase 3 clinical trials that could come to market as early as 2020. For this reason he strongly urges healthcare providers to refer patients with recurrent C. diff for these trials rather than for fecal transplants. In the meantime, the FDA reserves fecal transplants for patients who have experienced a second recurrence (third episode) of C. diff infection.
