Ask the doctors: Fecal transplant one option for treating C. diff infection

Dear Doctors: I was sick for months with debilitating pain, extreme weight loss, fatigue and loss of appetite. I was diagnosed with C. diff related to an abdominal surgery. I’m being treated with antibiotics, but I worry about the effects on my gut microbiome. Is a fecal transplant an option?

Dear Reader: For those who are not familiar, C. diff is short for Clostridioides difficile, a potentially life-threatening bacterium. If it takes up residence in the large intestine, C. diff can cause a range of gastrointestinal symptoms. The most common are colitis, which is widespread inflammation of the colon and persistent diarrhea. Additional symptoms include abdominal tenderness or pain, fever, nausea, loss of appetite and unintentional weight loss. Symptoms range from mild to severe and can lead to complications such as dehydration, bloody stool, low blood pressure, rapid heart rate and infection in the tissues of the colon.

C. diff infection is often associated with the use of broad-spectrum antibiotics, which disturb the equilibrium of the microbial colonies living in the colon. This disruption allows an overgrowth of opportunistic bacteria, such as C. diff, to occur. Inflammatory bowel diseases, which weaken the integrity of the colon, and reduced immunity are also risk factors.

C. diff spreads via the spores it produces. They are very hard to eradicate completely, which is why this infection is often seen in hospitals and long-term care settings.

Treatment depends on the severity of infection. For some people, stopping the broad-spectrum antibiotics that allowed C. diff to flourish can be adequate. When a C. diff infection is persistent, specific antibiotics, which target the bacterium, are prescribed.

The newest approach to aggressive or repeated C. diff infection is the fecal transplants you are asking about. Also known as fecal microbiota transplant, or FMT, the treatment involves inoculating the colon with healthy donor stool. This kick-starts the regrowth of the diverse colonies of intestinal flora that had previously kept adverse bacterial overgrowths in check.

The history of FMT dates back at least to fourth-century China, where written records detail the successful use of a fecal slurry to treat severe diarrhea. The modern version of the treatment, in which healthy stool is rigorously tested for safety and then specially treated for medical use, began in the mid-20th century.

When it comes to the success rate of FMT, the data are still not clear. This is a new approach, and treatment protocols have not yet been standardized. Initially, recovery rates were believed to be in the range of 90%. Newer data, which take into account repeat infections, suggest the success rate of FMT treatment for C. diff may be closer to 70%.

Your concerns about the antibiotic treatment you are undergoing are understandable. However, unlike broad-spectrum antibiotics, which suppress the entire gut microbiome, the drugs used in treatment of C. diff are targeted. At this time, FMT becomes an option when two rounds of antibiotic treatment fail to cure the infection. In cases of severe C. diff infection, or with recurrent infection, it may be a first-line treatment. Check with your internist to see if you may be a candidate.

Send your questions to askthedoctors@mednet.ucla.edu.