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Though inspiring endless bad puns like ‘poopsickle’ and “rePOOPulating the gut,” fecal transplants are nevertheless showing considerable promise for treating the enteric scourge of Clostridium difficile infections (CDIs). The form of this unique therapeutic approach ranges from pooled donor feces to individual donor feces, usually from a family member, screened for viruses and other pathogens.
Much excitement has been generated by a recently published study by a Dutch group wherein patients had vancomycin treatment, bowel lavage and then fecal transplant via a nasoduodenal infusion.(1) One single donor fecal infusion cured 13 of 16 patients, and a second fecal transplant from a different donor cured 2 of the remaining 3 patients.
Another group is working with a synthetic form of feces comprised of the major microbiota grown independently in the laboratory.(2) This Canadian group isolated 62 species from normal stool from one healthy donor and checked the isolates for antibiotic resistance. They ultimately chose 33 susceptible strains for their synthetic fecal mixture. Two initial patients were treated with the mixture and results mirrored those of normal feces based on extensive deep sequencing and sophisticated statistical tools. They call the process “rePOOPulating the gut.”
Once you have a mixture tested, preferably one from a mix of non-related donors, it is possible to freeze it for future patients. Hamilton and colleagues presented such an approach, testing it on 43 patients, some of whom had inflammatory bowel disease (IBD) and not CDI.(3) The IBD patients also seemed to respond favorably to this “poopsickle” approach.
Editor's note: For more on this story see the guest column in the April issue of Hospital Infection Control and Prevention by Ellen Jo Baron, PhD, professor emerita at Stanford University School of Medicine, in Palo Alto, CA.
1. van Nood E, et al. Duodenal Infusion of Donor Feces for Recurrent Clostridium difficile. N Engl J Med 2013; 368:407-415.
2 . Petrof EO, et al. Stool substitute transplant therapy for the eradication of Clostridium difficile infection: “rePOOPulating” the gut. Microbiome 2013;1:3 doi:10.1186/2049-2618-1-3.
3. Hamilton, MJ, et al. Standardized frozen preparation for transplantation of fecal microbiota for recurrent Clostridium difficile infection. Am J Gastroenterol 2012;107:761-7.