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article imageStool banks soon needed to treat C. difficile, a bowel disease

By Nancy Houser     Oct 1, 2013 in Health
Donations of feces at local stool banks may soon be an actuality due to a growing and deadly bacteria called Clostridium difficile. The bacteria is an antibiotic-resistant intestinal infection that can come from places like unclean toilet bowels.
Mayo Clinic reports that "Each year, more than a half million people get sick from C. difficile, and in recent years, C. difficile infections have become more frequent, severe and difficult to treat."
This is a bacteria disease that is called: (1) Clostridium Difficile Colitis; (2) Antibiotic-Associated Colitis; (3) C. difficile Colitis; (4) C. diff; and (5) C diff.
Causes of C. difficile
C. difficile is considered the most common gut bug infection and is rapidly growing into an epidemic problem. It is found in the soil, air, water, human and animal feces, and food products, such as processed meats. Certain people carry the bacteria in their large intestine with very few side effects. However, it is the health care field that is often associated with C. difficile, along with its association with antibiotics.
The primary antibiotic that is associated with C. difficile is clindamycin (Cleocin). But other common antibiotics include ampicillin, amoxicillin, and cephalosporins [such as cephalexin (Keflex)]. The National Institutes of Health report that the study, "Hospital-wide restriction of clindamycin: effect on the incidence of Clostridium difficile-associated diarrhea and cost," concluded hospital formulary restriction of clindamycin is an effective way to decrease the number of infections due to C. difficile.
A growing epidemic
This month's October Consumer Reports - On Health questions (on page 1) whether or not good bacteria can successfully fight this new medical threat that is causing approximately 14,000 deaths a year. Typically, patient numbers have been on the rise in elderly patients in long-term are units or hospitals. However, current numbers are rising in younger and healthier age groups from other health care settings: medical clinics, nursing homes, and doctor's offices.
According to, "More than three million C. difficile infections occur in hospitals in the US each year. After a stay of only two days in a hospital, 10% of patients will develop infection with C. difficile. C. difficile also may be acquired outside of hospitals in the community. It is estimated that 20,000 infections with C. difficile occur in the community each year in the U.S."
To make things even worse, the bacteria C. difficile, a spore-forming bacteria, is evolving into virulent strains that are resisting newer drug treatments, such as the emergence of the hypervirulent NAP1/BI/027 strain.
Symptoms of C. difficile
The symptoms of C. difficile develop within a couple of months after a person has completed their course of antibiotics (unnecessary antibiotics wipe out natural gut flora), with a multitude of symptoms:
Some people have loose stools during or shortly after antibiotic therapy.
-- Increased white blood cell count
-- Chronic diarrhea that is watery, occurring ten to fifteen times a day
-- Loose stools can occur during or after antibiotic therapy
-- Abdominal pain that causes cramping and abdominal tenderness
-- Intestinal inflammation
-- Nausea
-- Extreme fatigue
-- Weight loss
-- Dehydration that may cause hospitalization
-- Malnourishment
-- Inflamed colons
-- Swollen abdomen
-- Kidney failure
-- Fever
-- Blood in stools
-- Form patches in the intestines of raw tissue that can bleed or produce pus (pseudomembranous colitis)
NOTE: Physicians suggest that if a patient is taking an antibiotic and has three or more loose stools a day, a fever, severe abdominal pain, and/or blood in the stools, he or she should go to a doctor and be tested for C. difficile.
Fecal transplants
Mayo Medical School with the main building of the Mayo Clinic behind it in Rochester  Minnesota.
Mayo Medical School with the main building of the Mayo Clinic behind it in Rochester, Minnesota.
Fecal transplants are considered an emerging technique for individuals with C. difficile, with a MedPage Today reader suggesting the term "fecal transplants" be replaced with "pre-probiotic transplant."
The medical field reports that by 2014, stool transplants will be the standard treatment for Clostridium difficile. Healthy stools from donors can alter patients' fecal microbiota to resemble that of the healthy donor over time, studies report.
However, MedPage Today has posted that practitioners for fecal transplants will be required to obtain an IND ( Investigational New Drug Program) to use fecal transplant as a treatment for C. difficile, as the FDA has now classified that donor feces as a biologic drug in order to control the process.
Stool banks
"We hope that in the future, there will be stool banks, just like there are blood banks and sperm banks," said Lawrence Brandt, MD, professor of medicine and surgery at the Montefiore Medical Center in New York City. ( 20 Mind-Blowing Medical Breakthroughs, Readers Digest. 2013.
Donated stools on an individual basis per patient is different from a stool bank, something patients will see in the near future. However, protocol is the same once patients move beyond the "ick" factor. Of course, by the second time around with the disease, "ick" has moved way down the road. Currently, friends and families of the patient freely donate 50 grams of feces, screened to prevent viruses (HIV or hepatitis C) or other pathogens that would harm the patient. The donors occasionally donate on a routine basis for other patients, the beginning of stool banks of the future.
Mayo Clinic's Dr. Orenstein states that their fecal transplant program is distinguished rigorously for evaluating recipients and donors, but only for relapsing patients. "Our focus is on safety, measuring outcomes, appropriate follow-up and ongoing process improvement," he says. "Without regulation or standards, if something goes wrong, that could mean the end of this procedure for people who really need it."
Stools that are currently being donated are placed in a very inexpensive plastic plunger that is inserted into the patient's rectum, a five-minute procedure to re-establish the bacterial balance. The patient should be feeling better in 48 hours, with a 90% success rate for the disease.
Future fecal transplants will consist of two enema procedures that are less costly, once they are approved by health regulators.
(1) The colonoscopy requires the patient to be sedated while the donated stool is inserted into the colon.
(2) A plastic feeding tube is passed through the nose, down the throat and into the stomach. The donated feces are then fed into the tube.
C. difficile inpatient costs
MedPage Today reports that within the last eight months, C. difficile inpatient factors that added to the rising medical costs were an average of 12 days of hospitalization, intensive care units, orders of isolation, and multiple specialist consultants (infectious disease specialists and gastroenterologists). This totals to approximately $35,621 on the average.
Additional costs to patients on an individual basis were:
-- Diagnostic tests, with 60% of patients having colonoscopies, endoscopies, CT or MRI scans, sigmoidoscopies, or tests for obstruction.
-- Mucosal inflammation was identified in 16%, 2% required colectomy, and 0.4% had surgery for toxic megacolon.
-- Specialist consultations other than gastroenterology and infectious disease included intensivists in 5% and surgery in 25%.
-- A total of 7.6% of patients died during their hospital stay, with C. difficile infection being the cause of death in 21%.
In the United States, it is estimated that 3 million cases occur each year, with an excess cost burden for the health care system now exceeding $3 billion annually.
Dr. Orenstein points out. "With molecular biology and the sequencing of these species, this can only get bigger. It's like the beginning of the space program."
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