Featured Research

from universities, journals, and other organizations

Use of frozen material for fecal transplant successfully treats C. difficile infection

Date:
April 24, 2014
Source:
Massachusetts General Hospital
Summary:
A pilot study by Massachusetts General Hospital investigators may lead to greater availability and acceptability of an unusual treatment for a serious medical problem -- use of fecal material from healthy donors to treat recurrent diarrhea caused by the Clostridium difficile bacteria. The researchers report that use of prescreened frozen material from donors unrelated to patients was as successful in curing recurrent C. difficile as was the use of fresh fecal material reported in previous studies.

A pilot study by Massachusetts General Hospital (MGH) investigators may lead to greater availability and acceptability of an unusual treatment for a serious medical problem -- use of fecal material from healthy donors to treat recurrent diarrhea caused by the Clostridium difficile (C. difficile) bacteria. In their paper being published online in the journal Clinical Infectious Diseases, the researchers report that use of prescreened frozen fecal material from donors unrelated to patients was as successful in curing recurrent C. difficile infection as was the use of fresh material reported in previous studies of what is called Fecal Microbiota Transplant (FMT).

"We found that delivery of a frozen, stored inoculum through a nasogastric tube is safe, acceptable to patients and as successful as delivery by colonoscopy -- which requires a preparatory 'clean out,' sedation or anesthesia, and is quite costly," says Elizabeth Hohmann, MD, of the MGH Infectious Diseases Division, senior author of the report. "Without this treatment option, patients with recurrent C. difficile may have chronic diarrhea -- limiting their quality of life and their ability to maintain weight -- and need to live on chronic antibiotic treatment, which is both expensive and can have other side effects."

C. difficile infection has become an increasingly serious problem, causing around 250,000 infections requiring hospitalization and 14,000 deaths each year in the U.S. Hohmann notes that from two to five patients test positive for the infection at MGH every day. In patients with recurrent or treatment-resistant infection, long-term treatment with vancomycin or other antibiotics has had limited success, with symptoms recurring up to 30 percent of the time. In fact, antibiotic treatment has the potential of making matters worse, as it kills off the beneficial normal intestinal microbes that can keep pathologic species like C. difficile in check.

FMT probably treats C. difficile by restoring the normal balance of intestinal microbes. Previous animal and human FMT studies using fresh fecal material have had success rates of around 90 percent, but the MGH researchers note that recruiting and screening potential donors can be time-consuming and costly. Banking a supply of frozen, prescreened donor stool could significantly increase the availability of FMT, and the current study was designed to test the feasibility and effectiveness of such an approach, along with comparing two routes for delivery of the donor material.

Stool samples were donated by exceptionally healthy adults who received comprehensive screening for infectious diseases. Donors also were asked to refrain from eating any common allergens, such as nuts or eggs, in the days before donation. The donated fecal material was filtered, diluted, screened and frozen; stored for at least four weeks to allow retesting donors for any hidden infections; and prior to administration, thawed and kept refrigerated.

The study enrolled 20 patients -- three of whom were children -- who either had three or more episodes of mild to moderate C. difficile infection for which antibiotic treatment failed or had two episodes serious enough to require hospitalization. Participants were randomly divided into two groups -- 10 who received donor material by standard colonoscopy and 10 who received it though a nasogastric tube (NGT) passed into the stomach. A single administration was successful in curing 14 of the 20 participants -- 8 in the colonoscopy group and 6 in the NGT group, a difference not considered significant in such a small study.

Among those whose infections did not resolve, a single participant declined additional treatment. The other 5 received a second administration, which cured the infection in 4, for an overall success rate of 90 percent, similar to that of the previous studies. Participants who received the second infusion were allowed to choose the route of administration, and all chose to receive it via NGT.

Subsequently the researchers discovered that the participant who declined a second infusion was self-administering fecal enemas, using unprocessed material from his roommate, a practice Hohmann notes could be hazardous. "We certainly don't recommend 'home brew' FMT, since it's very important to screen donors properly. In addition, while some people may be comfortable using stool from a spouse or other intimate partner, many older patients might not have such a donor who is healthy enough to donate safely."

The research team also reports treating an additional 11 patients with frozen donor samples via NGT, achieving a 91 percent success rate, and they currently are investigating what may be an even more acceptable means of administration -- via a capsule that would remain undigested until it reaches the small intestine.

"It's been very gratifying to be able to help these patients, some of whom have been sick for a year or two," Hohmann explains. "They have told us this has been life changing for them and that they have gotten themselves back to normal. There aren't many things in medicine that have a success rate of more than 90 percent. Insurers may not want to pay for this, but it is very effective, makes patients better quite quickly and saves money overall. While it may never become a first-line treatment, we are starting to consider using it more and more often," she adds.


Story Source:

The above story is based on materials provided by Massachusetts General Hospital. Note: Materials may be edited for content and length.


Journal Reference:

  1. I. Youngster, J. Sauk, C. Pindar, R. G. Wilson, J. L. Kaplan, M. B. Smith, E. J. Alm, D. Gevers, G. H. Russell, E. L. Hohmann. Fecal Microbiota Transplant for Relapsing Clostridium difficile Infection Using a Frozen Inoculum From Unrelated Donors: A Randomized, Open-Label, Controlled Pilot Study. Clinical Infectious Diseases, 2014; DOI: 10.1093/cid/ciu135

Cite This Page:

Massachusetts General Hospital. "Use of frozen material for fecal transplant successfully treats C. difficile infection." ScienceDaily. ScienceDaily, 24 April 2014. <www.sciencedaily.com/releases/2014/04/140424102424.htm>.
Massachusetts General Hospital. (2014, April 24). Use of frozen material for fecal transplant successfully treats C. difficile infection. ScienceDaily. Retrieved July 24, 2014 from www.sciencedaily.com/releases/2014/04/140424102424.htm
Massachusetts General Hospital. "Use of frozen material for fecal transplant successfully treats C. difficile infection." ScienceDaily. www.sciencedaily.com/releases/2014/04/140424102424.htm (accessed July 24, 2014).

Share This




More Health & Medicine News

Thursday, July 24, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

New Painkiller Designed To Discourage Abuse: Will It Work?

New Painkiller Designed To Discourage Abuse: Will It Work?

Newsy (July 24, 2014) The FDA approved Targiniq ER on Wednesday, a painkiller designed to keep users from abusing it. Like any new medication, however, it has doubters. Video provided by Newsy
Powered by NewsLook.com
Doctor At Forefront Of Fighting Ebola Outbreak Gets Ebola

Doctor At Forefront Of Fighting Ebola Outbreak Gets Ebola

Newsy (July 24, 2014) Sheik Umar Khan has treated many of the people infected in the Ebola outbreak, and now he's become one of them. Video provided by Newsy
Powered by NewsLook.com
Condemned Man's US Execution Takes Nearly Two Hours

Condemned Man's US Execution Takes Nearly Two Hours

AFP (July 24, 2014) America's death penalty debate raged Thursday after it took nearly two hours for Arizona to execute a prisoner who lost a Supreme Court battle challenging the experimental lethal drug cocktail. Duration: 00:55 Video provided by AFP
Powered by NewsLook.com
China's Ageing Millions Look Forward to Bleak Future

China's Ageing Millions Look Forward to Bleak Future

AFP (July 24, 2014) China's elderly population is expanding so quickly that children struggle to look after them, pushing them to do something unexpected in Chinese society- move their parents into a nursing home. Duration: 02:07 Video provided by AFP
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:
from the past week

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile: iPhone Android Web
Follow: Facebook Twitter Google+
Subscribe: RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins