|
|
|
|
There’s no polite way to say this - C. diff superbug cure is a bit... gross |
|
Some of us worry that someday we may have to ask a loved one for one of their kidneys, part of their liver, or a little bone marrow for a life saving transplant. But few of us imagine we will ever ask a relative to give us crap — literally.
Fecal transplants have been successful in the treatment of the devastating and sometimes deadly Clostridium difficile superbug. And the treatment may become more and more common as outbreaks continue to plague hospitals, says a Sherbrooke specialist who is one of the very few Canadian doctors to use the technique.While the procedure sounds gross — even to some doctors — gastroenterologist Dr. Diane Langelier from the Centre hospitalier universitaire de Sherbrooke said it’s a surefire cure for C. difficile.“It’s effective. It’s cheap and there have been no complications, no infections or fever, in any of the patients I have treated with it.”One of the most common infections acquired in hospitals and long term care centres, C. difficile grows in the large bowel after antibiotics kill off the beneficial bacteria in the intestines and colon of patients, which allows the nasty invader to take over.The virulent bacterium multiply and produce toxins that cause a number of symptoms including chronic diarrhea, fever, dehydration, colitis, abdominal cramps and, in extreme cases, the infection can lead to death. Elderly patients and those with weak immune systems are at a higher risk of infection and death.A fecal transplant, also called fecal flora therapy, consists of injecting feces from healthy individuals into the bowels of patients suffering from recurring bouts of C. difficile to help restore normal intestinal function.CHUS gastroenterologist Langelier, who has performed the procedure 30 times over the past 15 years, says the donor’s stool “is full of intestinal flora that helps rebuild the ecosystem of the patient’s bowel, block the proliferation of C. difficile, and rebuild the normal intestinal bacteria the patients had before they contracted the bug.”While fecal transplants are an effective treatment in patients with recurring outbreaks of C. difficile, the procedure is rare because few doctors know about it. The treatment is also infrequent because it is only done on those scarce patients who suffer from recurring outbreaks of C. difficile, said Langelier, who recently presented the technique to a conference of Quebec and Spanish gastroenterologists. Even specialists who deal with stomach and bowel ailments made faces when she mentioned the title of her fecal transplant presentation, Langelier said.“We decided at the conference we have to come up with a less disgusting term, like fecal bacteriotherapy,” she said. “I’m asking for suggestions between now and the end of December.”Langelier told The Record she first used the technique in the early ’90s at the suggestion of CHUS gatroenterologist Dr. Henry Haddad, who had read articles about the technique which consisted of injecting fecal matter through a rectal tube.Langelier had a patient who was dealing with a fifth or sixth recurring episode of C difficile and Haddad came to her with the recipe for the fecal enema.The experience was a success and from 1992 to 2003 the CHUS treated 11 cases.But in 2003, the hospital was hit with an epidemic of C. difficile; there were more patients infected and more problems with recurring infections, said Langelier. The superbug has been linked to the deaths of at least 2,000 people in Quebec since 2003. Here at the CHUS, and at other hospitals in the Townships and the Montérégie, a much more virulent strain of the superbug was detected.Lagelier said that in 2004 and ’05, 16 patients received fecal transplants. In 2006, none were performed and this year a single patient was treated with fecal therapy.“We have a better control of the situation,” she said.The CHUS some reported 360 case of C. difficile between March 2003 and March 2004 year. In 2004-’05, there were 228 cases and in 2005-’06, fewer than 100.The number of cases dropped another 35 per cent this year.The overuse of certain antibiotics has been blamed for outbreaks because they destroy the intestinal lining and make the patient more susceptible to the superbug. Yet infected individuals are treated with strong antibiotics such as vancomycin or flagyl, said Lagelier.About 15 to 20 per cent of those people will have a recurring infection within two weeks because not all of the spores were destroyed or because they were re-infected by a new one.The second time patients are given a new round of antibiotics. Half of them get a recurring infection. “The more relapses a patients has, the more likely they are to have another relapse,” Langelier said. If patients contract a third infection, they are given a decreasing dose of antibiotics over a longer period of time. But if there’s a fourth episode, fecal therapy is proposed.Langelier said that, in general, patients react well when she suggests the unusual therapy. Finding a family member to donate reassures them, she said.“No one has refused the procedure,” she said. “After coming back to the hospital three or four times, and antibiotics won’t get rid of their problem, they are willing to try it.”New antibioticsOnce patients agree to a fecal transplant, they are started on a new round of antibiotics while a donor is found and tested. The therapy is administered once the antibiotics have begin to work and patients are feeling a little better. Langelier said the the donor is usually a close relative, a spouse, one of the patient’s children, a sibling, other relatives or a good friend. Lagelier said she usually tests two candidates in case one has to be rejected.Potential donors give a stool sample that is tested for bowel disease as well as parasites and bacteria (including C. difficile). Some people carry the C. difficile bug but are asymptomatic, Langelier said. They are also given blood tests to check for other diseases such as hepatitis and HIV.About 12 days later the patient is ready for fecal therapy and antibiotics are stopped 48 hours before.On the morning of the procedure, stool from the donor is collected and sent to a sterile microbiology laboratory where it is mixed with saline and strained to create a liquid rich in healthy bowel bacteria.Meanwhile the patients is prepared for a colonoscopy. Langelier said that at first, the liquid was injected through an enema. But in 2003 and 2004, when the patients were infected with a more virulent strain of the superbug, the technique was reevaluated and it was decided to inject it through colonoscopy, so it would go much further into the colon, close to the start of the large intestine. That not only allows for abetter retention of the fluid, it also spreads the good bacteria over a larger area.Later still, Langelier began injecting the through a nasal gastric tube that brought it straight to the patient’s stomach.In her latest fecal therapy procedures, Langelier has coupled both methods, what she calls treating the patient from both ends. The dual therapy was used in her last 11 cases, all of which led to patients beingcured.Langelier notes that with few medical papers on the subject, there is no standardized procedure for fecal transplants. While some hospitals have been using enemas or colonoscopy and other are using nasal gastric tubes, Langelier said she believes no one else is combining the two strategies.Of the 150 gastroenteralogist in Quebec, Langelier is the only one to perform fecal transplants to treat patients recurring C. difficile. A couple of doctors elsewhere in Canada, including in Calgary and Ajax, Ontario also use the unusual therapy.Lagelier said the possible application of the therapy have not been studied in depth.“There are a lot of grey zones to clarify,” Langelier said, noting that while fecal flora therapy is currently used in cases of recurring C. difficile outbreaks, she said research may determine it can be used on patients in the acute phase of the disease.But Langelier predicts fecal flora therapy will become more popular and more widespread as the number of C. difficile epidemics continues to rise.“In the next five years gastroenterologist and researchers are going to become more interested in fecal therapy.”By Rita LegaultNov. 19 |
|
|
|
Montreal Canadiens
