A Cure for C. diff? Simple Procedure Producing Miracle Results
Tags: c.diff, CDC acknowledges C.diff infection rates historically high, cure fo C. diff, fecal transplants working miracles, hospital acquired infections
When I first saw this story in Modern Healthcare, “Fecal transplants Gain Ground Against C. diff,” I had to take a closer look, because frankly, it’s personal. Having lost both of my parents over the last few years, and knowing that we all face such inevitability, I understood that anything about a “cure for C. Diff” was essential reading.
Basically, C. diff (Clostridium difficile) killed my mother. And to add some perspective, when she contracted it during her rehab (recovering from a stroke) in an “infected hospital” in Savannah, her doctors put it right out there and told me that it would likely be the eventual cause of her death. “About every six months, your mother will get sick from this bug and we will give her antibiotics. Most likely, she will respond favorably to the medication through the first several occurrences, but over time, she won’t, and it will eventually kill her.”
I was angry. Unrelated to her stroke, she had contracted a hospital borne “killer infection” (acknowledged as rampant at this particular facility) and that basically, there was nothing they (or I) could do about it?
In a March 2012 report, the CDC said that rates of C. diff had grown to “historically high” levels and were linked to 14,000 deaths annually.” And I have to say, that number feels low to me based on conversations I’ve had with physicians and others who would know. And to add insult to injury, what’s been discovered is that a decades-old procedure that uses donor feces to repopulate the intestines with “good bacteria” is producing near miraculous outcomes. “Physicians cite accounts of patients who struggled for months or even years with recurrent C. diff and who, after receiving a transplant, were symptom-free within a day or two.”
On Jan. 16, the New England Journal of Medicine published the results of the first-ever randomized controlled trial looking specifically at fecal transplant as a treatment for C. diff. Led by a group of researchers from the Netherlands, the study found a far higher success rate for fecal transplant through nasogastric tube than for treatment with Vancomycin, a powerful antibiotic often used to treat the infection. Vancomycin was the drug my mother received. The results were so striking that the trial was halted because of concerns that it was unethical to prevent patients in the control group from receiving fecal transplants.
Dr. Robert Orenstein, an infectious disease specialist at the Mayo Clinic (Phoenix) began doing fecal transplants in early 2011 after a patient with a severe, recurrent case of C. diff begged for the procedure. “We were in awe of the results,” he said. “The patient was near death and was probably going to have to have most of his colon removed. Twenty-four hours later, he was walking out of the hospital.” Like all the others who perform the procedure, Orenstein predicts it won’t be long until insurers begin reimbursing directly for fecal transplants. “It is so effective, it makes you wonder why we do anything else,” he said.
The price points for the procedure are running less than $2,000, which remarkably, includes the lab work required on the donor sample. In fact, the expense of the donor lab work is turning out to be 90% of the total cost for the procedure. Other than getting the sample into the patient’s intestines, there just isn’t that much more to it. In some hospitals, the procedure goes for roughly the cost of a colonoscopy, but in others, if the donor sample is approved, they just let the patients give it to themselves via an enema.
In an era where CMS won’t be paying the tab for readmissions related to hospital acquired infections (HAI), one might think that news of the procedure would have gone viral by now. But Dr. Clifford McDonald, a medical epidemiologist and C. diff expert at the CDC worries the “eww” factor could hinder the progress of this promising treatment –a treatment he says “could prove effective for treating other drug-resistant organisms.” “The term ‘fecal transplant’ places too much emphasis on the donated material, he says. A new term—his suggestions include ‘intestinal microbiota restoration’—could help people to better accept the procedure. We need to get over the fact that these good bacteria live in our bodies and are necessary,” McDonald said.
Frankly, it’s all kind of stunning to me. Despite being somewhat educated about our system (certainly not naive), I accepted a thoughtful recommendation and moved my mother to a hospital in Savannah, Georgia that was/is “sick” with C. diff –and that offers up neurologists to explain the killer bug after the fact. By the way, their explanations weren’t riddled with excuses. To the contrary, they (the neurologists and their explanations) were quite direct, reflecting their own resignation. It was almost like I was supposed to accept my mother’s HAI as nothing more than bad luck, despite the fact that almost every patient on two floors in that hospital were also infected, according to what I was told.
The “eww” factor Dr. McDonald talks about is, of course, meaningless to those of us who know people who have suffered and died from complications directly linked to C. diff. Not only have far too many died, but far too many continue to suffer.
Fecal transplants are working miracles for patients. The procedure is low risk and low cost. Spread the word.
Source: Modern Healthcare