Fecal transplants may be best answer to antibiotic-resistant bacteria

C. diffis the most common healthcare-acquired infection in the United States. It affects nearly half a million patients each year and becomes a recurring infection for nearly a third of them. If untreated,C. diffcan lead to sepsis and death.

"Twenty five years agoC. diffinfections were easier to manage and often resolved with discontinuation of the initiating antibiotic," says Robert Orenstein, DO, an infectious disease specialist at Mayo Clinic and lead author on this article. "However, these infections have become increasingly common and pernicious."

The standard and FDA-approved treatment forC. diffis a course of oral vancomycin, an antibiotic. However, even the medications used to eliminateC. diffcan perpetuate the infection by killing off beneficial microbes. Newer antibiotics that more specifically targetC. diffhave been developed but they can be prohibitively expensive, according to Dr. Orenstein.

"Think of your gut as a forest andC. diffas a weed," says Dr. Orenstein. "In a thriving forest, weeds barely get a foothold. But if you burn the forest down, the weeds are going to flourish."

不同于抗生素,具有破坏性的definition, fecal transplants or microbial replacement therapies, repopulate the gut with a diverse group of microbes that may block theC. diff's spore from germinating and propagating disease via its toxins. Transplants have several delivery methods, including enemas, capsules and direct instillation, to replace the diverse flora that maintain health and improve metabolism.

Currently, there are no FDA-approved fecal transplant products and performing fecal transplants is considered an investigational procedure. Dr. Orenstein notes there are several companies with products in Phase 3 clinical trials that could come to market as early as 2020. For this reason he strongly urges healthcare providers to refer patients with recurrentC. difffor these trials rather than for fecal transplants. In the meantime, the FDA reserves fecal transplants for patients who have experienced a second recurrence (third episode) ofC. diffinfection.

C. diffis common in healthcare settings and public spaces and rarely causes problems in people with healthy gut microbiota and immune systems, according to researchers. However, people who are already ill and taking antibiotics, chemotherapy, or proton pump inhibitors -- which all greatly disrupt the gut ecosystem -- are at risk. Elderly patients are especially vulnerable.

Dr. Orenstein expects the new treatment options will improve outcomes but says physicians need to assume greater responsibility for prevention.

"One of the most effective things physicians can do is become more responsible with antibiotic prescriptions," says Dr. Orenstein. "That means only prescribing when they are clearly indicated, not for colds or viral sinus infections. We also must be especially judicious with elderly patients."