Fecal Matters

Sometimes the most effective treatment comes from an unexpected source

By Quinn Eastman

FMT

Jack Kearse

NO. 1 FOR NUMBER TWO The work of physicians Colleeen Kraft (left) and Tanvi Dhere have made Emory a leading center in the treatment of C. difficile infection through fecal transplants.

When you’re facing a life-threatening infection, it’s good to have an open mind.

Fecal microbiota transplant, or FMT for short, has become an accepted treatment for recurrent Clostridium difficile infection, which can cause severe diarrhea and intestinal inflammation. Emory physicians Colleen Kraft and Tanvi Dhere are among the leading experts on how FMT restores microbial balance when someone’s internal garden has been disrupted.

C. difficile, or “C diff,” is a hardy bacterium that can barge into the intestines after another infection has been treated with antibiotics, when competition for real estate is low. Recently doctors around the world have shown that FMT can resolve recurrent C diff infection better than antibiotics alone.

Kraft and Dhere have performed almost three hundred FMTs and report a 95 percent success rate when treating recurrent C diff. They have established a pool of stool donors whose health is carefully screened.

Building on their experience with the procedure, Kraft and Dhere are studying whether FMT can head off other antibiotic-resistant infections besides C diff in kidney transplant patients, and have teamed up with infectious disease specialists Aneesh Mehta and Rachel Friedman-Moraco to conduct the study.

Kidney transplant recipients must take drugs—which suppress the body’s ability to fight infections—to prevent immune rejection of their new kidneys. As a result, kidney transplant recipients are exposed to a lot of antibiotics and are at higher risk for acquiring multidrug resistant infections. The most common bacterial infections requiring hospitalization after kidney transplant are urinary tract infections, which can lead to impaired graft function, graft rejection, and even deadly sepsis.

FMT has been previously performed at Emory with organ transplant patients and immunocompromised patients. The new study is for kidney transplant recipients who test positive for carbapenem-resistant Enterobacteriaceae and vancomycin-resistant Enterococcus. Doctors will test whether FMT can displace the antibiotic-resistant bacteria, so that last-resort antibiotics are not necessary.

Email the editor