Innovations like this are saving lives

Patrice Stech

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Fecal Microbiota Transplantation 'Saved My Life'

Innovative treatment cured recurrent C. difficile infections

As a stay-at-home mother, Patrice Stech needs strength, health and flexibility to nurture her three children, all under age 7. But a lengthy battle with recurrent Clostridium difficile infections compromised her ability to focus on her family.

"I was so sick I was willing to try anything," said the 34-year-old Olathe, Kansas, resident, who has suffered from nine bouts of the bacterial infection in 14 years. "I was constantly going to the bathroom with diarrhea, probably 20 to 30 times a day. A lot of times, it felt like a really nasty flu bug."

During each infection, Patrice would quarantine herself in her room for days waiting for antibiotics to take effect. Meanwhile, her husband obsessively cleaned the house with a water and bleach solution, hoping he and the children would avoid contact with the highly contagious bacteria.

Relief finally came in 2016 when Patrice underwent a fecal microbiota transplantation (FMT) at The University of Kansas Health System. This investigational treatment involves depositing a carefully screened stool sample into the sick individual's colon to reintroduce the healthy bacteria that normally reside there.

Patrice said FMT saved her life.

Addressing the stigma is the first step

Ask around, and many people will say they've never heard of FMT. And when they do, most recoil.

"There is an 'ick factor' for a lot of people," said gastroenterologist Mollie Jackson, DO. "But if someone is battling C. diff and has failed multiple antibiotic courses, I encourage them to be open-minded and think of FMT as an alternative medical option."

Infections are common – and can be deadly

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 six 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.

Antibiotics elevate risk

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 said. "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.

Flagyl® is a first-line treatment

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 said.

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 said.

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," said Dr. Jackson. "However, if you're not having improvement within three days or you have a recurrence, we would consider an alternative treatment."

Patrice Stech and her familyPersistence leads to a cure

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 said. "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."

OpenBiome supplies healthy samples

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 said. "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."

Success rates are high

Most of Dr. Jackson's FMT patients are referrals who have had three recurrences after their initial C. difficile infection. At that point, antibiotics only work about 35 percent of the time. There is an 80 to 90 percent 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 said. "I feel awesome. I'm a normal person now."