Transplanting fecal matter with healthy bacteria into patients with refractory Clostridium difficile infections can lead to quick relief, according to a new study.

Researchers at Integris Baptist Medical Center (Oklahoma City, OK, USA) and Montefiore Medical Center (New York, NY, USA;) conducted a study that included 77 patients (mean age 65, 73% women) who underwent a colonoscopic fecal-microbiota transplant (FMT) at least three months previously for recurrent C. difficile infection; 31 of the patients were hospitalized, homebound, or in a skilled nursing facility at the time the procedure was performed. The patients subsequently answered a 36-item questionnaire about the results of the transplant.

The researchers found that FMT was successful in 70 out of 77 patients (91%) who were on average elderly, debilitated, and had undergone multiple failed treatments, including antibiotic and probiotic therapies. The average duration of illness for these patients was 11 months, but after the procedure patients continued to improve and did not have a recurrence of C. difficile infection during the follow-up period. In six of the remaining seven patients, a single two-week course of vancomycin or a two-week vancomycin course plus one further FMT resulted in a 98% cure rate. The study was presented at the annual meeting of the American College of Gastroenterology, held during October 2011 in Washington DC (USA).

“Patients with recurrent C. difficile infection had a totally different population in their stool than normal people, characterized by a marked decrease in the diversity of species present,” said lead author and study presenter Mark Mellow, MD, of the Integris Baptist Medical Center. “Therefore, it would make sense that if you performed a massive bacterial replacement, that might very well reverse that condition and allow for a cure in people who were otherwise not curable.”

Clostridium difficile is a major cause of morbidity and increasing health care costs among hospitalized patients, causing infections that lead to diarrhea and is most often related to antibiotic use during medical treatment. C. difficile is especially dangerous for patients with weakened immune systems such as the elderly and those with Inflammatory Bowel Disease (IBD). Therapies for this difficult-to-treat subpopulation include antibiotics, probiotics, toxin-binding medications, active vaccination, intravenous immunoglobon, and FMT.

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