2023-04-25 01:22:22
The infection caused by the clostridium difficile bacterium, characterized by diarrhea, fever, nausea and abdominal pain, is most commonly treated with antibiotics; however, there is increasing evidence that fecal or stool transplantation may be a much more effective solution.
Compared with standard antibiotic treatment, stool transplantation can increase the number of people who recover from a Clostridioidium difficile infection by 40% to 77%.
Fecal microbiota transplantation can be administered by oral capsules, colonoscopy, or rectal enema, among other routes. This therapy consists of repopulating the intestine of a sick person with healthy bacteria, those that they should have and have somehow lost. To do this, a sample, previously processed in the laboratory, of the feces of a person in good health is introduced into the body of the patient.
A Cochrane review led by Upstate Medical University (USA) has found that, compared with standard antibiotic treatment, stool transplantation may increase the number of people who recover from a C. diff infection. 77% of people who received a fecal transplant did not experience a reinfection within eight weeks, compared to 40% of those who received antibiotics only.
C. difficile is a bacterium that can cause life-threatening diarrheal illnesses in people with an unhealthy mix of gut bacteria, known as dysbiosis. The most common cause of dysbiosis is antibiotic treatment, and while antibiotics can be very effective against bacterial infections, they can also harm the beneficial bacteria that colonize the gut, known as the gut microbiome. Usually this ecosystem of “good” bacteria recovers quickly, but sometimes “bad” species, such as C. diff, take over and cause severe diarrhea.
Standard treatment of C. diff infection includes antibiotics, which can further exacerbate dysbiosis.
Standard treatment of C. diff infection includes antibiotics, which can further exacerbate the dysbiosis. This can lead to a vicious cycle of short treatment effect followed by recurrent infection. This occurs in almost a third of infected individuals.
Fecal transplantation from a donor to a gut with dysbiosis is intended to balance the gut microbiota and restore a healthy microbiome, thereby significantly reducing the risk of C. difficile recurrence.
Donating stool works in a very similar way to donating blood. Donors are tested for disease and infection before donating their stool. Stool can be transplanted by colonoscopy, nasogastric or nasoduodenal tube, enema, or capsule.
Fecal transplantation is currently approved in both Europe and the US for the prevention of C. diff recurrence.
The new review, led by pediatric gastroenterologist Aamer Imdad, examined data from six clinical trials involving a total of 320 adults that evaluated the efficacy and safety of stool transplantation for the treatment of repeat C. diff infection.
Two studies were conducted in Denmark and one each in the Netherlands, Italy, Canada and the USA. Most of the included studies compared stool transplantation with a standard antibiotic treatment of vancomycin, which is commonly used for this type of infection. .
The review found that stool transplantation produces a greater increase in resolution of repeat C. diff infections than other treatments studied, as well as a decrease in side effects compared with standard antibiotic treatment.
“After someone with a C. difficile infection is treated with antibiotics, there is about a 25% chance that they will experience another episode of C. difficile infection within 8 weeks,” Imdad says. «The risk of recurrence increases to 40% with the second episode and almost 60% with the third. Therefore, once you enter this cycle, it becomes increasingly difficult to get out of it.
The review shows promising results for the
ulcerative colitis
; however, the data is still inconclusive
Stool transplants can reverse dysbiosis and thus decrease the risk of disease recurrence.
A second Cochrane review, also led by Imdad, examines the use of stool transplants for the treatment of inflammatory bowel disease (IBD), a term used primarily to describe two conditions: ulcerative colitis and Crohn’s disease. The review shows promising results for the ulcerative colitis; however, the data is still inconclusive.
The results for Crohn’s disease are less conclusive and more research will be needed before fecal transplantation can be considered for the treatment of IBD.
However, warns Toni Gabaldón, ICREA research professor and head of the Comparative Genomics group at the Institute for Research in Biomedicine (IRB Barcelona) and the Barcelona Supercomputing Center (BSC-CNS), “It can work in this type of alterations where there are no treatments effective, but there is a lot of inter-individual variability, both in terms of the donor of the fecal microbiome and the recipient.
And add to the Science Media Centre: “I think these approaches will improve when we have more detailed knowledge about the interactions between the microbiome and our immune system. Surely the technique will evolve towards more selective transplants, no longer of an entire fecal microbiotabut of defined microbial communities, different according to the patient and the indication».
To get there, he concludes, “we still have an arduous path of basic and applied research.”
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