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Fecal Microbiota Transplantation and C. difficile

Quick Facts! 

  • Fecal microbiota transplantation (FMT) is a treatment used for multiple recurrent cases of C. difficile infection (CDI)

  • FMT involves introducing a stool sample from a healthy person into the gut of a CDI patient in order to bring in backup for the “good” bacteria trying to fight off C. difficile

  • FMT is...

    • Effective - it has nearly a 90% cure rate

    • Safe - lots of sample and donor screening occurs before transplantation

    • More cost-effective (versus prolonged antibiotic treatment)

  • Side effects can include cramping, bloating, diarrhea or constipation, and mild abdominal pain. 

  • Long-term outcomes still need to be researched!

The Gut Microbiome... Our Silent Heroes

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Your digestive tract is home to millions of bacteria and we call this the gut microbiome. The bacteria there are, for the most part, harmless or beneficial. These populations of “good” bacteria in your gut are important for overall health as they play a key role in regulating your metabolism, warding off harmful infections, producing vitamin K, and more! (1) 

 

However, among these “good” populations of bacteria can also lay harmful pathogens like C. difficile. When antibiotics are taken with the goal of eliminating C. difficile, “good” bacterial species often get killed in the process. Since the “good guys” are weakened or wiped out, this gives C. difficile a higher chance of returning and wreaking havoc all over again. This is why, in C. difficile infection (CDI) patients, there is a 20-50% chance of getting a recurrent infection after treatment (2). In that case, another round of antibiotics can be prescribed. However, sometimes, the second round of antibiotics is ineffective and a third or even fourth episode of CDI can occur. What happens in these multiple recurrent CDI cases? Is all hope lost? 

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Fear not, this is where we introduce fecal microbiota transplantation (FMT). This section will tell you about all the important things you need to know about FMT as a treatment for multiple recurrent CDI. (3).

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Probiotics, Nutrition, and C. difficile

Quick Facts! 

  • Probiotics and food can help with antibiotic-associated diarrhea that is caused by C. difficile 

  • Research suggests that probiotics could be of benefit to CDI patients as well as for the prevention of infection altogether  

  • Lactobacillus strains can be useful at preventing CDI and S. boulardii could fight off recurrent infection

  • Soluble fiber and fermented foods are among the superheroes that can help stabilize gut bacteria

  • Use this information to be an empowered patient advocate and to learn more!

Probiotics and Nutrition?

At this point, you are probably aware of many of the problems associated with C. difficile infection (CDI) as well as some treatment options, including FMT, which highlights the importance of a strong, diverse microbiota. But transplanting samples from poop isn’t all it’s useful for. Did you know that probiotics, and by extension food, are critical to a healthy, functional gut? Well, you do now! Let’s break down why what we consume is so crucial to our gut health.


There are two related factors that have been shown to prevent CDI in at-risk patients as well as those at risk for recurrence: probiotics and nutrition.

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FMT References

1.       den Besten G, van Eunen K, Groen AK, Venema K, Reijngoud DJ, Bakker BM. The role of short-chain fatty acids in the interplay between diet, gut microbiota, and host energy metabolism. J Lipid Res. 2013;54(9):2325-40.

2.       Pepin J, Alary ME, Valiquette L, Raiche E, Ruel J, Fulop K, et al. Increasing risk of relapse after treatment of Clostridium difficile colitis in Quebec, Canada. Clin Infect Dis. 2005;40(11):1591-7.

3.       Song JH, Kim YS. Recurrent Clostridium difficile Infection: Risk Factors, Treatment, and Prevention. Gut Liver. 2019;13(1):16-24.

4.       Vindigni SM, Surawicz CM. Fecal Microbiota Transplantation. Gastroenterol Clin North Am. 2017;46(1):171-85.

5.       Wang JW, Kuo CH, Kuo FC, Wang YK, Hsu WH, Yu FJ, et al. Fecal microbiota transplantation: Review and update. J Formos Med Assoc. 2019;118 Suppl 1:S23-s31.

6.       Youngster I, Russell GH, Pindar C, Ziv-Baran T, Sauk J, Hohmann EL. Oral, capsulized, frozen fecal microbiota transplantation for relapsing Clostridium difficile infection. Jama. 2014;312(17):1772-8.

7.       Cammarota G, Ianiro G, Gasbarrini A. Fecal microbiota transplantation for the treatment of Clostridium difficile infection: a systematic review. J Clin Gastroenterol. 2014;48(8):693-702.

8.       van Nood E, Vrieze A, Nieuwdorp M, Fuentes S, Zoetendal EG, de Vos WM, et al. Duodenal infusion of donor feces for recurrent Clostridium difficile. N Engl J Med. 2013;368(5):407-15.

9.       Arbel LT, Hsu E, McNally K. Cost-Effectiveness of Fecal Microbiota Transplantation in the Treatment of Recurrent Clostridium Difficile Infection: A Literature Review. Cureus. 2017;9(8):e1599.

10.     Gupta A, Khanna S. Fecal Microbiota Transplantation. Jama. 2017;318(1):102.

11.     Leshem A, Horesh N, Elinav E. Fecal Microbial Transplantation and Its Potential Application in Cardiometabolic Syndrome. Front Immunol. 2019;10:1341.

Nutrition and Probiotics References

1.        Probiotics: What You Need to Know: National Center for Complementary and Integrative Health; 2019 [Available from: https://www.nccih.nih.gov/health/probiotics-what-you-need-to-know#hed1.

2.        Gareau MG, Sherman PM, Walker WA. Probiotics and the gut microbiota in intestinal health and disease. Nature reviews Gastroenterology & hepatology. 2010;7(9):503-14.

3.        Evans CT, Johnson S. Prevention of Clostridium difficile Infection With Probiotics. Clin Infect Dis. 2015;60(suppl_2):S122-S8.

4.        Pattani R, Palda VA, Hwang SW, Shah PS. Probiotics for the prevention of antibiotic-associated diarrhea and Clostridium difficile infection among hospitalized patients: systematic review and meta-analysis. Open Med. 2013;7(2):e56-67.

5.        Tung JM, Dolovich LR, Lee CH. Prevention of Clostridium difficile infection with Saccharomyces boulardii: a systematic review. Canadian journal of gastroenterology = Journal canadien de gastroenterologie. 2009;23(12):817-21.

6.        Peng Z, Ling L, Stratton CW, Li C, Polage CR, Wu B, et al. Advances in the diagnosis and treatment of Clostridium difficile infections. Emerg Microbes Infect. 2018;7(1):15.

7.        Soliman GA. Dietary Fiber, Atherosclerosis, and Cardiovascular Disease. Nutrients. 2019;11(5).

8.        Christiansen S. What to Eat When You Have Clostridium Difficile (C. Diff) 2020 [Available from: https://www.verywellhealth.com/c-diff-diet-4773546#citation-9.

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