National Post | News; Mon Nov 4 2013; Section: Canada; Byline: Tom Blackwell
A suburban Toronto hospital is asking its patients to make an unusual - and somewhat smelly - deposit upon their admittance to the facility.
North York General is building what may be the world's first fecal self-banking system, collecting and freezing patient stools to use as an antidote against possible infection with C. difficile.
The fledgling poop bank is the latest step in the development of a remarkable, if mildly nauseating, treatment for a hospital-acquired super bug that has claimed thousands of Canadian lives.
It would lower the bar, because all of a sudden you have all or most of the benefits of stool transplant, but you've taken away all of the major risks
Transplants of fecal material are designed to restore the natural, positive bacteria that normally reside in the gastro-intestinal tract and keep C difficile at bay. Studies have suggested the low-tech, unorthodox measure can eradicate illness even in patients who have suffered repeated, debilitating bouts.
Hospitals now acquire stools from close relatives or, failing that, unrelated donors, but experts say transplanting someone else's excrement - and the many unidentified microbes it harbours - could be courting disaster. Some hospital administrators have balked at allowing the practice.
North York's idea is to avoid that risk, and the time-consuming screening now done for known diseases.
That way, the treatment could be provided more readily, perhaps making it a first-line treatment, rather than a last-ditch one, says Dr. Kevin Katz, an infectious-disease specialist at the hospital.
"It would lower the bar, because all of a sudden you have all or most of the benefits of stool transplant, but you've taken away all of the major risks," he said. "If it's your own, you're just giving back what you normally have."
Dr. Katz and Sumit Raybardhan, an infectious-disease pharmacy practitioner at North York General, have started a pilot study to establish the feasibility of a bank. A broader trial of the concept would follow if all goes well, they said.
C. difficile disease typically afflicts patients in hospitals and nursing homes being treated with antibiotics that can destroy most bacteria in the gut. With freedom to replicate and produce toxin, the C. diff bugs can cause severe diarrhea, killing hundreds of people a year, many of them elderly.
The primary treatment for C. difficile infection, paradoxically, is with more antibiotics, but about 20% of patients end up having recurrences within a month, and many of those have repeated attacks, said Dr. Katz.
The fecal transplants from donors are being tried at a smattering of institutions, delivered in a solution either as an enema, or down a feeding tube threaded through the nose. A University of Calgary doctor has experimented with putting the solution in a more palatable pill form.
Results have been impressive. A small Dutch study published in the New England Journal of Medicine found that 15 of 16 patients with recurring C. difficile were cured with the treatment, versus 30% of a group given drugs.
Donors are screened with the same kind of tests - for infectious diseases like Hepatitis and HIV - used on organ or blood donors.
Poop, though, is a different story than blood, which is relatively sterile. Feces contain as many as 500 different species of bacteria, not to mention assorted fungi, and many of those microbes are a mystery, with the potential, at least, to be harmful to some people, said Emma Allen-Vercoe, a microbial ecologist at Ontario's University of Guelph.
At a meeting Prof. Allen-Vercoe attended this past weekend, a doctor voiced the fear that a patient will sooner or later "contract something horrible" from a fecal transplant.
"That's terrifying, right?" she said. "What we're doing now is a little primitive - you're taking poop and putting it in someone else. We usually think of it as a waste product. ... Using the patient's own stool gets around that whole issue."
Screening the donor is an impediment, too, taking as long as two weeks, said Dr. Susy Hota, who is conducting her own trial comparing fecal transplants with conventional drug treatment. The infectious disease specialist at Toronto's University Health Network also applauded North York's self-banking idea.
"The thought of taking their own stool ... is really like the ultimate in personalized medicine," said Dr. Hota. "It comes from you, it's been with you your entire life. Theoretically, that would be the best type of stool to take and repopulate your microbiota with."
Both experts, though, noted a potential drawback.
The gastro-intestinal "ecosystem" of certain people may contain something that makes them more susceptible to the illness than others, they said. So it is possible that transplanting back their own feces will help patients in the short run, but not cure them of C. difficile, said Prof. Allen-Vercoe.
The North York project has garnered consent from 30 patients, with about six having made deposits so far. The stools are mixed with a saline solution in a special blending machine called a "stomacher," then stored in a freezer at minus-70 Celsius.
Dr. Katz's hope is that one day the transplant of one's own feces will be a standard and rapidly administered treatment for the disease.
"You could look at people who are coming in for elective surgery and say, 'Would you like to bank your stool?' "