Clostridium difficile infection
Clostridium difficile is a spore-forming bacterium which is probably most commonly 'caught' through the mouth often in hospitals, especially after the use of antibiotics. It can result in syndromes of varying severity including transient diarrhoea, a carrier status, a mild colitis-like illness, pseudomembranous colitis, and even toxic megacolon with possible mortality.
Most affected patients can respond to medical therapy including discontinuation of the responsible antibiotic.4 It is not the antibiotic that causes the infection but rather the antibiotic use weakens the defence of the bowel bacteria so permitting C. difficile to implant in the bowel. Treatment with metronidazole (Flagyl), vancomycin, rifampicin, teicoplanin or bacitracin can be successful in clearing up the symptoms. However, despite a seemingly successful initial treatment around 25% or more patients may have a recurrence of diarrhoea following withdrawal of these specific antibiotics. This is thought to occur because the normal flora may not at this time, possess the power to eradicate the persisting Clostridial spores. In many patients the C. difficile spores remain and a chronic, relapsing disease can continue. Treatment of this recurrent C. difficile diarrhoea can be particularly difficult, mainly because we do not have the tools to kill spores. Various approaches to therapy have included resins such as cholestyramine (Questran) and colestid (Colestipol) granules, specific probiotics such as Lactobacillus GG, Saccharomyces boulardii and intravenous immunoglobulin.5 Ultimately, if all medical therapies fail, re-colonisation of the colon using human faecal origin probiotics has been used and reported to be successful in eradicating spores.6
The PTRC generally treats chronically ill patients who have had recurrent C. difficile diarrhoea, colitis or previous pseudomembranous colitis. We focus particularly on those cases where other therapies have failed. In such patients we may initially use a combination therapy with vancomycin, rifampicin and metronidazole together combined with Lactobacillus GG. If all pharmacological therapies fail, faecal microbiota transplantation (FMT) is used to terminate the C. difficile infection since human faecal flora bacteria appear to have the capability to permanently eradicate C. difficile spores - a treatment not able to be matched by any other currently known therapy. Using FMT, the cure rate approaches 90-95%.7-13