Issue link: https://viewer.e-digitaledition.com/i/426110
F OR ONE YEAR, the patient suffered multiple recurrences of C. diff infec- tion (CDI), resulting in repeated hospitalizations. Following a six- to eight-week hospital stay due to continuous diarrhea related to CDI, the patient was referred to Colleen R. Kelly, MD, Assistant Professor of Medicine at The Warren Alpert Medical School of Brown University and gas- troenterologist at Women's Medicine Collaborative. Having performed f e c a l m i c r o - biota transplant (F M T ) a s a curative therapy for CDI in otherwise healthy patients, Dr. Kelly was prepared to offer the same treatment to this patient. A colleague who specializes in infectious disease cautioned against FMT in this case, citing the presumably increased risk to patients on immunosuppressants. However, the patient would die if the CDI persisted, so Dr. Kelly performed the procedure. Bacterial Ecology Repeated cycles of antibiotics can disrupt the balance of native bacterial fl ora, allow- ing vicious bacteria to proliferate and cause serious infections, such as CDI. Dr. Kelly's experience using FMT to treat otherwise healthy patients led her to believe the therapy would be effective and safe for the immunocompromised patient as well. "Your colon has trillions of bacteria in it, and [most] people walking around aren't infecting themselves from the bacteria they carry," Dr. Kelly says. "So I hypoth- esized that doing FMT would restore the gut bacteria to a more normal state and [immunocompromised patients] wouldn't necessarily be at any increased risk of having those bacteria translocate out of the gut into other parts of the body and cause infection." That hypothesis was borne out when the patient enjoyed rapid, signifi cant and lasting FECAL MICROBIOTA TRANSPLANT THERE SEEMED TO BE NO OPTIONS. AFTER UNDERGOING AN ORGAN TRANSPLANT, THE PATIENT WAS PRESCRIBED HIGH-DOSE IMMUNOSUPPRESSANTS, WHICH FACILITATED ACCEPTANCE OF THE DONATED ORGAN BUT ALSO CRIPPLED THE PATIENT'S INFECTION- FIGHTING MECHANISMS. THE MUTED IMMUNE RESPONSE ALLOWED CLOSTRIDIUM DIFFICILE (C. DIFF) BACTERIA TO DISRUPT THE PATIENT'S GUT BACTERIAL BALANCE. OFFERS HOPE TO IMMUNOCOMPROMISED PATIENTS By Michael Ferguson COV ER FE AT UR E