One year ago, 90-year-old Nettie Hoffman developed pneumonia and was prescribed antibiotics. Soon after that, she developed C. difficile. After a successful fecal transplant, Nettie describes life after C. difficile. (Video: Michael Garron Hospital)
“Chief Poo Mixer” may not be Maureen Taylor's official title, but she wears the name with a badge of honour.
As a Physician Assistant in Infectious Diseases at Michael Garron Hospital (MGH), Maureen is mixing up what she refers to as “poop slurries” – a mixture of healthy stool and saline – to carry out fecal transplants on patients with Clostridium difficile (C. difficile). MGH is one of a handful of centres in Canada to offer the procedure.
C. difficile is a bacterial infection that can cause symptoms ranging from abdominal pain and diarrhea to life-threatening inflammation of the colon.
Symptoms that 90-year-old Nettie Hoffman knows all too well.
One year ago, Nettie developed pneumonia and was prescribed antibiotics. Soon after that, she developed C. difficile. Most cases occur in a hospital environment after a patient has taken antibiotics, which can alter the balance of good bacteria in the gut, allowing C. difficile to multiply and cause diarrhea.
According to Health Quality Ontario, from Jan.1- March 31 2018, there were 636 confirmed cases of hospital-acquired C. difficile in Ontario.
“About 20 per cent of people with C. difficile will have a relapse. It comes back and in those patients, they have recurrent diarrhea and it makes it hard for them to get out of the house,” says Dr. Jeff Powis, Medical Director, Infection Prevention and Control.
“It can have such a huge impact on their satisfaction in life.”
This was true for Nettie.
“I felt so negative and weak – this feeling of insecurity from extreme diarrhea. I had to be very careful about where I was going and how I was dressed,” she explains.
“I felt so far gone that this might be the end.”
The standard treatment for C. difficile is antibiotics like vancomycin and fidaxomycin, but in many cases, they don't eradicate the infection.
“We can probably get it under control but then patients can't get off of the drug,” says Maureen. “Every time they try to get off of the antibiotic, the infection comes back.”
Dr. Powis describes the difficulty of trying to treat recurrent C. difficile.
“It's a challenge because we give people more antibiotics, which in a way doesn't make sense because we are continuing to kill the good bacteria.”
So Jeff, Maureen and Dr. Janine McCready are offering patients at MGH a life-changing alternative.
Fecal bacterial therapy (FBT) takes a healthy person's stool and puts it into someone with recurrent C. difficile. This repopulates the colon with good, healthy bacteria and prevents C. difficile from coming back.
“We know we have millions of bacteria in our stool and this is an instant shot of probiotics, better than any yogurt you will ever have,” says Maureen.
And Nettie is reaping the benefits.
Michael Garron Hospital now has four volunteer FBT donors who are screened every year for infectious diseases including human immunodeficiency virus (HIV) and hepatitis, as well as intestinal parasites. Their stool is collected every couple of months, and then mixed with saline in the lab. These “poop slurries” can be frozen up to 30 days before expiring. The procedure is performed via enema and takes less than one minute. Two transplants are completed one week apart for extra reinforcement.
“I didn't know if it would work. I had been told that it was a healthy donor so I was enjoying piece of mind,” says Nettie. “It wasn't painful and it was decidedly more economical than antibiotics!”
The hospital continues to look for donors who meet the criteria. Given MGH is one of few centres, many patients continue to travel near and far, across the province for the procedure.
“The treatment works 85 per cent of time and the lives of patients are changed when they have normal bowel movements. It's actually pretty incredible,” says Jeff. “Of all the things I do, this probably makes one of the biggest differences in patients who are suffering from this.”
Maureen echoes the sentiment and challenges why more centres in the province don't offer the simple, life-altering and cost-effective procedure. While fecal transplants are considered the golden standard of care for patients with recurrent C. difficile, there are still too few doctors willing to do the procedure.
In a Healthy Debate article published this spring, Maureen, along with Jeff and Janine, challenged infectious disease physicians to step up.
“As clinicians we've all had times when we've had to do that little extra, maybe even for a little less, to help a patient,” they wrote. “It's time for all of our infectious disease colleagues to start giving a crap, and provide fecal bacteriotherapy for the patients who need it.”
As for Nettie, she is thriving in her new normal.
“They waved a magic wand over me,” she says. “I felt, gee, life is still here.”