In this video, you’ll learn about the process of fecal microbiota transplantation for treating recurrent C. diff infection.
You’ll see what C. diff is, what causes it, and how it's typically treated.
Then, you’ll learn how FMT products are prepared and made safe for patients.
Finally, you’ll learn the benefits and risks of FMT along with important strategies for preventing C. diff infection.
What is C diff?
Clostridioides difficile, previously called Clostridium difficile and also known as C diff, is a bacterium that causes swelling or inflammation of the large intestine.
Common symptoms of a C diff infection are diarrhea, abdominal pain, nausea, loss of appetite, and weight loss.
C diff can make you very weak and can also lead to social isolation, fear of spreading it to others, or stress.
You may be wondering, what causes this infection?
Normally, there are trillions of good bacteria living in our large intestine.
They help us digest food and also keep out the bad bacteria.
When the good bacteria in our gut are no longer balanced, C. diff can grow and take over.
So what causes this imbalance?
Taking antibiotics is the most common cause, because they can also kill our good bacteria.
This imbalance is called dysbiosis.
Other things that may put you at risk of C. diff infection include: previous infection with C. diff, being 65 or older, having a weakened immune system, or having recently had a hospital stay.
So, how do you treat a C diff infection?
Ironically, the way we treat C diff infection is by using another antibiotic, such as vancomycin.
These antibiotics will kill some C diff bacteria, but they will also kill good bacteria at the same time.
Some C diff bacteria are also hard to kill with antibiotics because they can go dormant by forming spores to evade antibiotics.
For most people, C. diff infection will go away with a course of antibiotics.
But for some people, the infection can recur, meaning it can come back again and again.
This is called recurrent C. diff infection.
This means that while you take vancomycin, your diarrhea clears up, but after you stop vancomycin, C diff and diarrhea come back.
If the infection comes back, it usually comes back 2 to 4 weeks after you have finished vancomycin.
How do you treat a recurrent C. diff infection?
If you have a recurrent C. diff infection, vancomycin can be like a bandage: it may stop some symptoms, but it is not treating the actual problem.
To get past the band aid effect of vancomycin, we use fecal microbiota transplantation, or FMT.
FMT allows us to transfer good bacteria from a healthy donor into your gut.
FMT is regulated by Health Canada for the treatment of recurrent C diff infection to make sure both the donor and the recipients are safe and protected from harm.
A common question is about how we make sure FMT is safe.
First, stool donors are screened very carefully to make sure that their stool will not cause an infection in a recipient.
Donors are not able to donate stool if they have conditions like irritable bowel syndrome, inflammatory bowel disease, or a family history of colon cancer, just to name a few.
Second, the donor stool is tested for any harmful bacteria and viruses, such as E. coli, salmonella, HIV, hepatitis B, hepatitis C, COVID-19, and mpox, among many others.
It may be reassuring to know that there are actually more tests done on donor stool than are done on donated blood!
How is the FMT treatment made?
The stool donation from a screened donor is mixed with water and then the large undigested particles are filtered out.
This creates a liquid suspension with good bacteria.
This suspension is freeze-dried so it becomes a powder which can then be packaged into capsules or re-suspended in water, depending on how the treatment is to be given.
How is FMT given?
The good bacteria from a donor can be transferred to your gut by a colonoscopy (a tube through your rectum), gastroscopy (a tube through your mouth), capsules (medicine that is taken by mouth), or a feeding tube (where a machine sends food from a bag into your body through a tube).
There are benefits and drawbacks to each delivery method.
For example, taking FMT by pills is the least invasive, but this will not work if you have trouble swallowing pills.
Giving FMT by colonoscopy is more invasive, but it may also allow your healthcare team to find other problems such as inflammatory bowel disease or bowel cancer that they would not have been able to detect otherwise.
What are the risks of FMT?
There is a risk of getting an infection from the donor stool despite all the testing, especially if there is an infection that we currently do not have a test for.
Because it is a relatively new procedure, the long-term consequences of FMT are not yet fully known.
We always have to consider the risks and the benefits of any medical treatment.
For FMT, the benefits far outweigh the risks.
What should you expect after FMT?
The success rate after FMT is very high.
At least 8 out of 10 people don’t have another C diff infection after a single FMT treatment.
Some people may need a second FMT treatment.
If your diarrhea does not come back 8 weeks after your FMT, you can consider your recurrent C. diff infection cured.
Some common side effects of FMT include abdominal pain, bloating, gas, constipation, and nausea. These symptoms usually don’t last long and they go away on their own.
What are ways you can help to stop the spread?
To stop the bad bacteria from spreading, clean your hands often with soap and water.
Also, make sure you clean the bathroom regularly with bleach while you still have C. diff diarrhea.
If you can use a separate bathroom while you have a C diff infection, that is even better.
To make sure your C. diff infection does not come back, avoid unnecessary antibiotics.
For example, a cold is most often caused by a virus and does not need antibiotics.
If you do need to take antibiotics, remind your doctor of your C. diff history, and request a low dose, narrow spectrum antibiotic if possible.
Always listen to your doctor and pharmacist, and avoid mixing medicines.
Lastly, make sure you're focused on eating nutritious meals.
That’s the best thing that you can do for your gut.
Eating a balanced diet with plenty of fibre, including fruits and vegetables, allows your good gut bacteria to keep growing.
Thank you for watching this video.
For further information, visit myhealth.alberta.ca to learn more about FMT or talk to your local healthcare provider!
