What is C.DIFF?
Clostridium difficile (C.diff) infection is the leading cause of infectious diarrhea in a hospital setting. It is also an increasingly urgent cause of death and disease in the United States, specifically in populations over 65 years of age. [i] It is an infectious gastroenteritis that presents with watery diarrhea and can lead to toxic megacolon, septicemia, and death. [ii] The most recent Antibiotic Resistance report from the CDC noted that between 2000 and 2007 the incidence increased 400% and since then has continued to rise including an antibiotic resistant subset. The CDC also reports that based on data through 2012 C.diff infections cost the American medical system $1 billion in excess medical costs. [iii]
Due to rising incidence, antibiotic resistance, and refractory infection, FMT has become an effective strategy to treat C.diff not responding to standard therapies. FMT delivery methods include nasogastric, colonoscopic, retention enema, and oral encapsulated pills. There has been little difference found between efficacies of delivery methods. All delivery methods show resolution after initial treatment in approximately 90% of patients treated. [iv, v, vi]
Increasing healthcare costs for not only multiple rounds of antibiotics, but also colonoscopy delivered FMT, can limit access to this life-saving therapy. Multiple rounds of antibiotics can cost over $2,000 and often are not covered by Medicare. Oral encapsulated FMT can be delivered for a fraction of the cost of both antibiotics and FMT via colonoscopy. In addition, there is much less risk and fewer side effects involved. Recent research reveals FMT frozen oral capsules to be 96.2% effective against recurrent C. diff infection. [vii] FMT has been shown to be incredibly safe with few minor side effects like bloating and diarrhea and severe adverse events being extremely rare. [viii]
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[i] Pardi DKS. Clostridium difficile Infection: New Insights Into Management. Mayo Clinic. 2012;87(11):1106-1117.
[ii] Martin JSH, Monaghan TM, Wilcox MH. Clostridium difficile infection: epidemiology, diagnosis and understanding transmission. Nat Rev Gastroenterol Hepatol. 2016;13(4):206-216.
[iii] U.S. Department of Health and Human Services Center for Disease Control and Prevention. ANTIBIOTIC RESISTANCE THREATS in the United States, 2013.
[iv] Pardi DKS. Clostridium difficile Infection: New Insights Into Management. Mayo Clinic. 2012;87(11):1106-1117.
[v] Youngster I, Russell GH, Pindar C, Ziv-Baran T, Sauk J, Hohmann EL. Oral, capsulized, frozen fecal microbiota transplantation for relapsing Clostridium difficile infection. JAMA. 2014;312(17):1772-1778.
[vi] Gough E, Shaikh H, Manges AR. Systematic review of intestinal microbiota transplantation (fecal bacteriotherapy) for recurrent Clostridium difficile infection. Clin Infect Dis. 2011;53(10):994-1002.
[vii] Kao, D., Roach, B., Silva, M., Beck, P., Rioux, K., Kaplan, G. G., … Louie, T. (2017). Effect of Oral Capsule– vs Colonoscopy-Delivered Fecal Microbiota Transplantation on Recurrent Clostridium difficile Infection: A Randomized Clinical Trial. JAMA: The Journal of the American Medical Association, 318(20), 1985–1993.