'Fecal Flora Reconstitution' Shows 'Very Dramatic Results' With C Diff, Researcher Says

   Clostridium difficile caused relatively manageable disease until 2000, when an epidemic strain emerged. There developed more cases and more severe cases as well as fluoroquinolone resistance. Famously, there was a serious outbreak in Quebec hospitals in the early 2000s.

   The management of  C diff infection was discussed at Internal Medicine 2011, the annual meeting of the American College of Physicians in San Diego. In her presentation, Christina M. Surawicz, MD, professor of medicine at the University of Washington School of Medicine in Seattle, described an innovative therapy that has gotten much attention -- not a little of it from the popular press -- over the past several years.

   "What I'm really excited about is fecal microbiota transplant, basically stool transplant," she said in an interview; the procedure is also called fecal flora reconstitution (FFR). "I resisted doing this for a long time because the idea of fecal enema from someone else to a patient shows how desperate patients and their doctors are. But I got a lot of patients with C diff and I tried all the standard treatments and at one point there became no other option. I've done 19 cases so far. The results were very dramatic."

   With colleagues, she published a report based on the cases last year in the Journal of  Clinical Gastroenterology. Out of the 19 patients, 18 initially responded to treatment with a single FFR treatment and one patient responded after a second FFR infusion. All 19 patients maintained prolonged cured status when they were followed until submission of the article, ranging from six months to five years.

   "You have to get over your disgust," Dr. Surawicz says. "You are putting someone else’s healthy stool into your patient." To deal with the "someone else" issue, she preferentially uses stool from the spouse, partner, family member, or close friend. The donor is tested appropriately for infections or other disqualifying conditions.

   "The patient preps for colonoscopy. I have the donor, the night before, take milk of magnesia so the stool is more liquid. They come in with the stool sample. I take take the stool, filter out particulate matter because it might clog up the scope. I smash the stool into nonbacteriostatic saline, draw it up into about five or six 60-cc syringes, go up with a  colonoscope, and just flush the healthy stool into the colon and that’s it."

   According to Dr. Surawicz, "the donor flora stays in the recipient for up to one month, allowing the good flora in that person's colon to survive and start to reproduce," effectively repairing the damage done when antibiotic overuse has wiped out much of the native flora that normally would protect the patient against Clostridium difficile.