Cure for killer bug - but there's a catch
IN THE annals of medical history, this could go down as one of the most effective but stomach-churning treatments ever devised.
Scientists seeking a cure for a deadly superbug have successfully treated patients using human faeces.
Trials in a Scottish hospital have shown patients suffering from the Clostridium difficile bug can be cured using 'donor stool' administered via a tube through the nose into their stomach.
Clostridium difficile was last week at the heart of a damning report into cleaning failures at the Maidstone and Tunbridge Wells NHS Trust in Kent, which resulted in the deaths of 90 patients.
Around 6,000 Scots are affected every year by the severe and potentially fatal form of infectious diarrhoea. Six patients at the Victoria Infirmary in Glasgow are currently being treated for the infection in an isolation unit.
Clostridium difficile is a particular problem among patients who have been prescribed strong antibiotics as they also wipe out the so-called 'friendly' disease-fighting bacteria in the intestine. Faecal 'transplants', as they are known, are believed to restore the bacteria to levels at which they help the recovery process.
Doctors involved in the trials admit there are "obvious aesthetic problems" in the treatment, which involves patients ingesting a liquidised sample of faeces from a partner or close relative.
However, the treatment has the potential to save the lives of hundreds of patients infected with one of Britain's most serious hospital-acquired infections.
Traditional treatment of Clostridium difficile involves the use of antibiotics. But doctors at Glasgow's Gartnavel Hospital have conducted a trial of 'faecal transplants' on 12 patients for whom antibiotics had failed to stop repeated bouts of the infection.
Following the treatment, nine of the patients had no further incidents of the illness. One was initially cured but was later reinfected. The remaining two patients had a further bout but then responded well to antibiotics. A source close to the study said: "The antibiotics basically upset the delicate ecosystem within the gut and that allows the Clostridium difficile to take over and cause problems."
Faecal transplants allow doctors to reintroduce friendly bacteria into the gut, from a donor, using 30g of faeces. These recolonise the recipient's gut, restoring the health of the large intestine and killing off the bug.
The process takes about two weeks, during which donors are screened for suitability and other treatments are tried out. The key requirement is that donors should not have recently been on antibiotics themselves.
Doctors then mix the donated faeces with water to allow it to travel through a tube. Despite the positive results, doctors stress that they still regard the faecal transplant as a "last resort" because it is cumbersome and the idea of is unpleasant.
But Ian Poxton, professor of microbial infection and immunity at the University of Edinburgh and chair of the European Study Group on Clostridium difficile, said: "People with recurrent problems will try anything. This is patient driven.
"It involves a transplant from the spouse or another relative with a healthy gut. The donor is screened to make sure they do not have Clostridium difficile or anything that the patient would not want to catch."
He added: "There is something in the faeces that is working and the next step is to isolate that so that it could be made into a treatment."
Dr Alisdair MacConnachie, specialist registrar in infectious diseases at Gartnavel Hospital, presented a report on the new treatment to the Scottish Microbiology Society's symposium in Glasgow on hospital acquired infections.
MacConnachie decided to try the idea in 2003 with a patient with long-term recurring Clostridium difficile after a US study flagged up the idea.
His study is believed to be the first of its kind, and shows that the treatment can work on the clinical front-line.
The investigation concludes: "This technique is time consuming to set up and suffers from obvious aesthetic problems. However, it does offer a treatment to patients who have repeatedly failed to settle with conventional therapy." Clostridium difficile has been causing concern in recent years as it is far more difficult to kill through conventional hospital cleaning than MRSA. In Scotland, the number of sufferers who have died has risen in the past five years from 170 in 2001 to 313 in 2005.
Up to half of sufferers can experience repeated bouts despite antibiotic treatments.
Its spores can survive in the environment for a long time, resisting cleaning by detergents, and can spread from patient to patient. It is best controlled through regular handwashing with soap and water.
A Scottish Government spokeswoman said: "We would encourage boards to share any information on good practice when tackling infections such as Clostridium difficile."
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