Researchers Advocate 'RePOOPulating' the Gut for Eradication of Clostridium difficile Infection

Fecal bacteriotherapy (stool transplant) can be effective in treating recurrent Clostridium difficile infection, but concerns of donor infection transmission and patient acceptance limit its use.

Petrof and Gloor, et al. (2013) describe the use of a stool substitute preparation, made from purified intestinal bacterial cultures derived from a single healthy donor, to treat recurrent C. difficile infection that had failed repeated standard antibiotics. Thirty-three isolates were recovered from a healthy donor stool sample.

Two patients who had failed at least three courses of metronidazole or vancomycin underwent colonoscopy and the mixture was infused throughout the right and mid colon. Pre-treatment and post-treatment stool samples were analyzed by 16S rRNA gene sequencing using the Ion Torrent platform.

Both patients were infected with the hyper-virulent C. difficile strain, ribotype 078. Following stool substitute treatment, each patient reverted to their normal bowel pattern within two to  threedays and remained symptom-free at sixmonths. The analysis demonstrated that rRNA sequences found in the stool substitute were rare in the pre-treatment stool samples but constituted more than 25 percent of the sequences up to sixmonths after treatment.

The researchers say this proof-of-principle study demonstrates that a stool substitute mixture comprising a multi-species community of bacteria is capable of curing antibiotic-resistant C. difficile colitis. This benefit correlates with major changes in stool microbial profile and these changes reflect isolates from the synthetic mixture. Their research was published in Microbiome.

Reference: Petrof EO, Gloor GB, et al. Stool substitute transplant therapy for the eradication of Clostridium difficile infection: RePOOPulating the gut. Microbiome 2013, 1:3 doi:10.1186/2049-2618-1-3.