It is a well-known fact that bacteria are everywhere, even certain strains can be found in our bodies in small concentrations. However, it is not well known that not all bacteria are bad. Good bacteria, otherwise known as probiotics, are any bacteria that are beneficial to a host; they are found within the body- in the mouth, throat and GI tract- and in certain foods we eat, such as yogurts, pickles, and sauerkraut.
Our bodies have several built-in immune defenses that help prevent and fight off bacterial infections. Even though these defenses are not perfect and we occasionally fall sick due to bacterial infections, we can look to antibiotics to help our bodies get rid of the invading microbes.
The downside of many antibiotic treatments is that in the process of eliminating bad bacteria from the body, they often kill a significant proportion of gut flora- the good bacteria found in the intestinal tract- which allows bad bacteria to multiply excessively, leading to infection. Clostridium difficile (C. diff) infections are a common side-effect associated with antibiotic treatment. Once one’s gut flora has been unfavorably altered, their microbiome is said to be in a state of dysbiosis; in this state, C. diff multiplies beyond normal proportions and produce a toxin that causes severe diarrhea and pseudomembranous colitis (inflammation of the large intestine).
Antibiotic classes with the highest risk of C. diff infection include fluoroquinolones, cephalosporins, clindamycin, and carbapenems. Common courses of therapies used to treat C. diff infections include antibiotics, aimed to reduce the levels of C. diff in the body, probiotics, to restore the gut flora, and surgery, used in very serious cases involving organ failure and severe damage to the colon. Fortunately, fecal microbial transplantation (FMT), a procedure that dates back to 4th century China, has recently proved to be a low-cost, highly effective treatment for recurrent C. diff infections.
The process of fecal microbial transplantation is the transfer of fecal matter bacteria from a healthy donor into the gut of a recipient. Stool from the donor is obtained and screened and then mixed into a solution that can contain egg, saline, or buttermilk, before being strained and transferred into the recipient via colonoscopy, retentive enema, or nasogastric tube.
Recurrent C. diff infections have become a major concern for healthcare professionals and patients. Antibiotic treatment is currently the primary treatment option, however, about 30% of patients that receive this treatment will suffer a recurrence of the infection, and, about 50% of those individuals will experience a second recurrence. According to the Center for Disease Control and Prevention (CDC), in 2011 there were approximately 453,000 cases of C. diff infection, 83 000 recurrences, and 15 000 deaths. FMT has proven to be the ideal treatment for recurrent C. diff; in cases where recipients didn’t respond to the initial FMT treatment, repeat treatments were almost always effective. Although the exact mechanism by which FMT works is still yet to be discovered, the practice has proved the ability of donor fecal bacteria in restoring gut flora in recipients.
Recurrent C. diff infections are a major burden on healthcare systems. The CDC reports that of the estimated 347,000 people diagnosed with C. diff infections in the U.S in 2012, at least 14,000 of them died. There is good evidence that Fecal Microbial Transmission is a highly effective, low-cost treatment for recurrent C. diff based on previous clinical uses, although further research is still needed for it to become a standardized practice. The procedure also shows promising efficacy in treating other digestive diseases such as Irritable Bowel Syndrome, functional gastrointestinal disorders, and Crohn’s disease.
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