Fecal transplants are defeating C. diff, but reimbursement issues unresolved
... fecal transplants gain ground against C. diff
Its mere mention sparks nervous giggles and sideways glances. But fecal transplantation, a decades-old procedure that uses donor feces to repopulate good bacteria in the guts of patients with recurrent infections, is gaining popularity as a highly effective method of treating resistant cases of the bug Clostridium difficile.
Physicians who perform the procedure say the results are often miraculous. They cite accounts of patients who struggled for months or even years with recurrent C. diff and who, after receiving a transplant, were symptom-free within a day or two.
But for the growing number of hospitals seeking to join the few that perform fecal transplants, lingering questions about reimbursement, the absence of standardized guidelines and the hurdles associated with finding appropriate donors can make the procedure seem more daunting than cringe-inducing.
Poor antibiotic stewardship and increasing resistance have contributed to ballooning C. diff rates, even as hospitals have made significant progress in fighting other types of healthcare-associated infections. In a March 2012 report, the Centers for Disease Control and Prevention said rates of C. diff had grown to “historically high” levels and were linked to 14,000 deaths annually.
Boca Raton (Fla.) Regional Hospital began performing fecal transplants on patients with severe C. diff in the last quarter of 2012 and has done six or seven transplants so far, said Dr. Charles Posternack, chief medical officer at the 394-bed hospital. “The procedure makes such scientific sense: C. diff grows because we kill off the normal flora, so let’s put it back,” he said. “It’s a simple concept, but the trouble is in operationalizing it.”
Boca Raton Regional Hospital requires that patients have their own donor who undergoes a number of screenings for hepatitis A, B and C, HIV and other diseases and pathogens. Once the donated sample is obtained, it’s homogenized in a blender and inserted via colonoscopy, Posternack said.
The colonoscopy and some of the initial tests can be billed to insurance companies, but for uninsured patients who have the procedure done at Boca Raton, the total bill is about $3,000. That pales in comparison to the medical bills of many patients with recurrent C. diff, who face long hospital stays and even stints in the intensive-care unit, Posternack contends.
On Jan. 16, the New England Journal of Medicine published the results of the first-ever randomized controlled trial looking specifically at fecal transplant as a treatment for C. diff. Led by a group of researchers from the Netherlands, the study found a far higher success rate for fecal transplant through nasogastric tube than for treatment with vancomycin, a powerful antibiotic often used to treat the infection.
Doctors are still waiting for standardized guidelines on fecal transplants to battle Clostridium difficile bacteria, above.