C. Difficile Treatment Success in Kansas City

While an important means of treating certain infections, antibiotics can clear the GI tract of the healthy bacteria that generally stave off C. difficile.

"Antibiotics distort healthy gut flora and make an avenue for C. diff and other bad pathogens to flourish," Dr. Jackson says. "When that happens, the person gets sick."

Those who are 65 or older, have been exposed to antibiotics, have had a recent hospitalization, are pregnant, have inflammatory bowel disease, use acid suppression proton pump inhibitors or are immunocompromised are at a higher risk for C. difficile infections.

On average, 500,000 Americans per year contract C. difficile. Between 14,000 and 30,000 people die from it annually.

According to Dr. Jackson, C. difficile infections are more common than they used to be and are on the rise for several reasons:

• C. difficile spores can live on hard surfaces for 6 months, increasing the chances of infection.
• The bacteria have mutated and become more resistant to antibiotics.
• Overuse of antibiotics predisposes our gastrointestinal tracts to infection.

For Patrice, C. difficile infections began with an antibiotic she took for routine illness.

"I would get sick with an ear infection or a urinary tract infection and have to take an antibiotic for it," Patrice says.

That antibiotic would upset the healthy balance of organisms in her GI tract, allowing C. difficile to invade and flourish. Over 14 years, each time she had an illness that required an antibiotic, the cycle would begin again.

Early on, Patrice's former doctor recommended her severely inflamed colon be removed. Patrice's mother insisted on a second opinion. Patrice was introduced to Flagyl, which successfully treated the C. difficile infection.

"Antibiotics always cured the infection, and that's why my previous doctor never recommended fecal transplantation," Patrice says.

But the antibiotic was only a temporary fix. The infection always returned.

"Flagyl should be considered the first line of treatment for your first occurrence if you have mild to moderate disease," says Dr. Jackson. "However, if you're not having improvement within three days or you have a recurrence, we would consider an alternative treatment."

Patrice and her husband relentlessly searched the internet for a better solution. Her husband was the first to suggest FMT. Friends in the medical field backed his suggestion, but because her previous doctor had said she wasn't a candidate, Patrice dismissed the idea.

Then, Patrice's husband found a link to Dr. Jackson and The University of Kansas Health System. Patrice agreed to a visit and learned that FMT offered great potential to stop her C. difficile infections once and for all.

"When I met Dr. Jackson and her nurse, Max, they were so excited for me," Patrice says. "Dr. Jackson was straightforward. She told me the hardest thing I would have to do is find a donor. After that, they would take care of the rest."

There is a screening process that includes reviewing the donor's history and obtaining blood work and stool studies. Patrice turned to her sister-in-law, who agreed. The morning of Patrice's procedure, her sister-in-law provided the stool sample, and Patrice took it with her.

"The sample can be deposited through a nasogastric tube, enema, colonoscopy or pill," Dr. Jackson said. "We have seen the highest success rate via colonoscopy at this time."

Unlike Patrice, patients no longer bear the responsibility to identify a donor. The University of Kansas Health System now subscribes to OpenBiome, a stool bank that operates much like a blood bank. Established in 2012, OpenBiome identifies donors and performs all testing.

"Some patients, such as the elderly, don't have anyone they can ask," Dr. Jackson says. "Further, if a family or friend agreed to donate, they may incur the costs of testing because insurance does not always cover it. OpenBiome removes all those barriers."

Most of Dr. Jackson's FMT patients are referrals who have had 3 recurrences after their initial C. difficile infection. At that point, antibiotics only work about 35% of the time. There is an 80-90% success rate with FMT.

Most patients feel better within a few days of their treatment. Typically, one transplant procedure is enough.

Patrice's last C. difficile infection was in September 2016. Today, she is celebrating a year of being healthy and free of recurrences.

"FMT may sound weird and gross, but it really is the best decision," Patrice says. "I feel awesome. I'm a normal person now."