Unusual transplant making a difference against superbug
Stool transplants are curing severe C. diff in patients
For eight years, Melvina Slemp suffered recurring bouts of diarrhea that left her skin raw and caused her family to worry she would die from dehydration.
Doctors prescribed drug after drug, but Slemp’s illness would return when she went off the antibiotics.
“It got to the point we couldn’t leave the house,” said Slemp’s daughter, Cindy Hudson of Cedar Rapids. “I finally got fed up.”
Slemp, 88, was diagnosed with Clostridium difficile, or C. diff, a bacterial infection that plagues people in hospitals, nursing homes and other care facilities. C. diff is on the rise nationally and in Iowa, and doctors are seeing it pop up in otherwise healthy people.
Overuse of antibiotics is blamed for C. diff’s explosion because the drugs strip disease-fighting bacteria along with the germs. Some doctors believe the best way to stop C. diff is to reintroduce healthy bacteria from an unusual source — poop.
Stool transplants are becoming the go-to treatment for patients with recurring C. diff because human feces, often donated by a healthy family member, contains natural gut flora that can kill diseases like C. diff.
The saline-diluted stool is introduced into a patient’s gastrointestinal track as part of a colonoscopy or by enema or a tube put down the patient’s nose.
“It’s such a simple treatment, but there’s that ‘ick’ factor,” said Dr. Henning Gerke, a gastroenterologist at University of Iowa Hospitals and Clinics who has done 10 stool transplants since April.
The success factor is also compelling. Stool transplants have an 85 percent to 95 percent cure rate for C. diff patients for whom drugs didn’t work.
C. diff deadly, expensive
C. diff is linked to 14,000 deaths a year, according to a March report from the Centers for Disease Control and Prevention. That number is likely low because it’s based on death certificates, which often don’t say when a patient died of related problems, such as kidney failure.
The number of U.S. hospital stays related to C. diff remains at record levels of about 337,000 annually, adding at least $1 billion in costs to the health care system, the CDC reported.
In 2000, there were fewer than 40 cases per 10,000 hospital discharges across the country. That more than doubled to nearly 90 cases per 10,000 discharges in 2010.
Iowa had 99 C. diff cases per 10,000 discharges in 2011, according to data collected by the Iowa Healthcare Collaborative.
Starting in January, acute care hospitals will be required to report their C. diff numbers to the CDC.
“C. diff has become a superbug,” said Dr. Dean Abramson, a gastroenterologist at Gastroenterologists P.C. in Cedar Rapids.
Not only are there more cases of C. diff, but the symptoms are more severe, including perforated colons, dehydration and even death. About 30 percent of patients have recurrences after they go off medication, Abramson said.
The traditional last-ditch treatment for people with recurring C. diff was to remove the colon, which requires significant life changes, including wearing a colostomy bag to collect waste.
Slemp and her family were getting desperate when Hudson read online about stool transplants.
“I got ahold of Dr. Gerke — thank God,” Hudson said. “He fought because they weren’t going to let him do it.”
Roadblocks to treatment
UI officials balked at stool transplants, because the procedures aren’t approved by the Food and Drug Administration. So far, there are no controlled studies with one group of C. diff patients receiving the transplants and another group getting traditional medication.
Insurance companies won’t reimburse hospitals for the procedures, Gerke said.
Pharmaceutical companies aren’t big on the transplants, either, because they are an alternative to C. diff drugs, some of which cost $1,000 per week, Abramson said.
“It doesn’t have ‘Big Pharma’ behind it, because how are you going to patent poop?” he said.
UI infectious disease experts and lawyers decided the patient benefits outweighed the potential risks, Gerke said.
The UI screens stool donors for diseases like HIV and hepatitis but has donors collect their own stool, so the hospital doesn’t have to charge for that part of the process. UI Hospitals turn in insurance claims for the colonoscopies, Gerke said.
St. Luke’s Hospital in Cedar Rapids also has decided to start performing stool transplants, with the hospital paying any costs that won’t be reimbursed by insurance, Abramson said.
Slemp’s transplant in April was the first at the UI. So far, she’s symptom free without antibiotics.
“She looks the best she has in eight years,” Hudson said.
Steps for preventing C. diff
Health care facilities and patients must work together to slow the spread of Clostridium difficile, a hardy bacterium that can kill patients and drive up medical costs, doctors said.
Cases of clostridium difficile, or C. diff, have more than doubled in the past 10 years, with most doctors and infectious disease experts blaming overuse of antibiotics. C. diff, which causes severe diarrhea, flourishes in patients whose healthy bacteria have been stripped away by antibiotics.
It’s not just doctors to blame for overuse of medications.
“We have to re-educate the public,” said Dr. David Elliott, a gastroenterologist at the University of Iowa Hospitals and Clinics. “They think their doctor isn’t taking care of them if they don’t give them a prescription.”
The Centers for Disease Control and Prevention released in March six steps for care facilities to prevent the spread of C. diff. These include:
- Prescribe and use antibiotics carefully. About 50 percent of all antibiotics given are not needed
- Test for C. diff when patients have diarrhea while on antibiotics or within several months of taking them
- Isolate C. diff patients
- Wear gloves and gowns when treating C. diff patients
- Clean C. diff patients’ rooms with bleach or other spore-killing disinfectant
- When a patient transfers, alert the new facility if the patient has a C. diff infection