Doctors have searched for years for a way to save the lives of patients infected with C. difficile, a treacherous bacteria that often stalks the halls of hospitals and nursing homes, attacking the weak and the elderly.
The infection can cause severe diarrhea and life-threatening bowel inflammation, especially in patients treated extensively with antibiotics, which can kill off many "good" bacteria and allow dangerous ones like C. difficile to proliferate. Tens of thousands of patients develop the infections each year, and doctors say they are becoming harder to treat.
In many cases, C. difficile infections resist even the most powerful antibiotics -- the ones hospitals reserve for such emergencies -- which leads to recurrent rounds of illness.
Doctors have no effective standard therapy for C. difficile patients, says Josbert Keller, a gastroenterologist at the University of Amsterdam, co-author of a study on a new treatment. So they're trying something decidedly non-standard: restoring the body's normal intestinal balance, not with drugs but with beneficial microbes excreted by healthy patients.
In other words, they're performing fecal transplants, also known euphemistically as "bacteriotherapy."
The procedure, which is rejected by 10% of eligible patients, cured 94% of those using it, mostly on the first treatment, according to Keller's study of 43 people published online today in The New England Journal of Medicine.
Fifteen of 16 patients randomly assigned to the therapy were cured, although two needed a second transplant, says the study, led by doctors from the Netherlands and Finland. The treatments were so successful that researchers stopped the study early, deciding it wasn't ethical to withhold them from the other patients, who were getting either antibiotics alone or antibiotics combined with bowel cleansing.
In comparison, 31% of those given antibiotics alone were cured, along with 23% of those randomly assigned to antibiotics plus bowel cleansing.
"This could be viewed as another form of recycling: One man's waste is another man's treasure," says James Versalovic, professor of pathology and immunology at Baylor College of Medicine and Texas Children's Hospital. It has its own fecal transplant program, which it calls "intestinal microbiome transplantation."
Though the transplants aren't yet the standard of care, Versalovic says the new study will make more physicians consider it for patients with recurrent infections.
In the future, doctors may be able to purify donated feces so they transplant just the bacteria that people need, Versalovic says.
Fecal transplants are one of the first new treatments to emerge from the study of the "human microbiome." That's the collection of 100 trillion mostly benign bacteria, fungi and other microscopic bugs that live in and on the human body and without which people could not survive, says Lita Proctor, who leads the National Institutes of Health's Human Microbiome Project.
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