When Katherine Kosche was going through training and residency 20 years ago, clostridium difficile infection — a bacterium that causes inflammation to the colon and chronic diarrhea — was often seen in older patients that were taking a lot of antibiotics and had been in the hospital for a long period of time.
But now the gastroenterologist at Memorial Hospital West says cases of the infection, commonly referred to as CDI, have been rising over the past 10 years and seen in a variety of patients, young and old.
“It is a bacteria, and it is believed to be allowed to spring forward when you’ve killed off some of the good guy bacteria in the colon,” she said. “CDI is probably around all the time. We may all have CDI that comes and goes through our system, but because you have healthy bacteria in your gut, it doesn’t create a disease.’’
Today, however, CDI remains at historically high levels and causes diarrhea that is linked to 14,000 annual deaths in the United States, according to the Centers for Disease Control and Prevention.
Kosche says increased cases of CDI may be linked to antibiotic overuse. Symptoms include pain in the lower abdomen, loose bowel movements, diarrhea, fever, bleeding, nausea and loss of appetite.
Patients who seek medical care for symptoms of CDI will be given a stool test to identify the cause of the diarrhea before treatment is given. Antibiotics are usually prescribed for two weeks to treat the infection, which can be tough to kill, Kosche said.
Although antibiotics are the first approach to treating CDI, there is a high relapse rate with the antibiotics, Kosche said. For many patients the CDI will recur a week after the antibiotic treatment is finished, and a stronger — and usually more expensive — antibiotic will need to be administered.
But even after two antibiotic treatments, a number of patients will continue to relapse. Kosche says she has patients who relapse every time they stop taking antibiotics, even after being treated numerous times.
“The sicker you are when you get it, the sicker you may be in the long run,” she said. “Those elderly patients unfortunately get the very worst version of it. Patients in outpatient that I am seeing are feeling pretty crummy, but still soldiering on in most cases.”
Kosche is now offering fecal microbiota transplantation (FMT) as a safe and effective treatment for recurring CDI. The treatment allows for the reintroduction of healthy bacteria in the gut, and has more than a 90 percent success rate.
During FMT, fecal matter from a healthy individual — who does not suffer from diarrhea — is infused into the gastrointestinal tract of the sick patient. Kosche says the idea of FMT is to allow healthy bacteria to control the CDI.
“Many people think of bacteria as being bad, but in fact, many bacteria are good,” she said. “Since we know that CDI is under control in healthy guts, the idea is to give the bacteria that lives in a healthy person to a sick person.”
Although FMT has been around for more than 50 years, it wasn’t widely used until recently. Donors must be healthy, have normal bowel movements, not have been on any antibiotics for the preceding six months and must not frequently travel to areas with endemic diarrhea. Blood and stool tests are performed before the transplant takes place in order to ensure that the donor does not have parasites, bacteria, hepatitis, or sexually transmitted diseases.
Kosche says that patients who have relapsed numerous times and have failed all other treatments should explore the possibility of a fecal transplant.
“You don’t have to suffer in silence. Be open about it because you can be helped.”