Normal microbiota can benefit the host by preventing theovergrowth of harmful microorganisms. This phenomenon is called microbial antagonism, or competitiveexclusion.
(Gerard, Funke, & Case, 2016) Fecal Transplantsare widely used for treatment for persistent infections. Humans with a current Clostridium difficileinfection are the research tool for the experiments. There are changes in the recipient’s biologydue to the attribution of multiple bacterial cells in the donor feces (Bojanova & Bordenstein, 2016). There are other compositions that the colon canbenefit from fecal transplants. Some ofthose components include colonocytes, archaea, viruses, fungi, protists, andmetabolites. Pediatric Fecal microbiotatransplantation is also done to manipulate the gut microbiota in children thathave to take long term antibiotics. (Mir, Kellermayer, & Gulati, 2014). Antibiotics cause diarrhea because they alterthe normal intestinal flora and decreases colonic bacteria resulting inmalabsorption of carbohydrates and osmotic diarrhea.
Antibiotics leads tocolonization and toxin production by Clostridium difficile, which may causediarrhea and pseudomembranous enterocolitis. Fecal transplantation procedure is performed at the same time when anenema is done.Clostridium DifficileClostridium difficile, also known as c-diff, is an infectivediarrhea.
Clostridium difficile has been around for a while, the first knowncase was in 1978. C-diff is a toxin producing bacteria that causes antibioticassociated colitis. It is one of the leading causes of nosocomial infections inhospitalized patients.
C-diff has increased the morbidity and mortality inhospitalized patients. The symptoms of C-diff are watery diarrhea possibly withpus or blood, abdominal pain and cramping, dehydration, loss of appetite,nausea, and possibly fever. (Khanna, 2012) The risk factors for older adultsare frequent interactions with health care systems and the changes that comewith age such as the gut microbiome. There are other therapies that include fidaxomicin, and fecalbacteriotherapy, which has an excellent outcome.
(Jump, 2013) Ingestion of infectious organisms are thecause of diarrhea. Organisms attack theintestines in many ways. Clostridiumdifficile impairs the absorption by destroying cells and creating inflammationof the colon. A person is influenced bygenetic susceptibility to pathogenic organisms. A healthy colon contains short chain of fatty acids and bacteria such asE. coli that aid in the fermentation and prevent pathogenic bacteria fromgrowing. (Medical Surgical Nursing, pg. 1007) Stomach acid is the first line ofdefense against ingested pathogens and some medications are designed todecrease stomach acid giving the increase of susceptibility to infection.
ClostridiumDifficile in the Pediatric Population Antibiotics are not the Only Main Cause1Some Antibiotics kill the normalflora and expose the digestive system to infection. Patients that receive broad-spectrumantibiotics such as clindamycin, cephalosporins and fluoroquinolones aresusceptible to pathogenic strains of C. difficile because those medicationsproduce inflammation and destroy cells in the colon. (Medical Surgical Nursing,1007). There have been studies donesuggesting other consistent causes for Clostridium Difficile.
The causes can besevere underlying illnesses, non-surgical gastrointestinal procedures,anti-ulcer medications, nasogastric tube and, duration of hospital stay. (Bignardi, 1998). Antidiarrheal medications are contraindicated in the treatment ofinfectious diarrhea because it could stretch the time to the exposure of theinfection.Fecal TransplantFecal transplants involve transplanting fecal matter to theintestines via enema, gastroscope, or nasojejunal tube. The FDA recently relaxed the restriction onthis procedure.
Before 2012, the FDA wasnot supportive of fecal transplants due to the risk of contracting diseases suchas Hepatitis A. Stool transplantation involves taking a stool specimen from amember of the patient’s household, diluting it in normal saline, andadministering it as an enema. (Lewis, Dirksen, Heitkemper, Bucher, & Camera, 2012). By introducing healthy bacteria by this procedure,it re-establishes the colonization of the good bacteria to prevent clostridiumdifficile infection. Fecaltransplantation is also known as fecal bacteriotherapy or intestinal microbiotatransplantation. The FDA has alreadyrecommended Fecal microbiota transplantation as a form of treatment forpatients with C.
Diff after a round of vancomycin regiment. Fecal microbiota transplantation has shown tohave remarkable therapeutic results with inflammatory bowel diseases, irritablebowel syndrome, metabolic diseases, neuropsychiatric conditions, autoimmunediseases, allergic disorder, and chronic fatigue syndrome. (Brandt, 2012) Therestill ongoing studies with fecal microbiota transplant in a form of apill. The FDA still unsure on regulatingfecal transplants pills due to not agreeing about infectious diseases enteringthe body through the first gastrointestinal barrier, so the FDA decided tolabel the pill as an experimental drug. The FDA is also concerned that patients could contract HIV, hepatitisand other parasites from fecal matter.
(News/AP, 2014). Dr. Thomas Louie, an infectious diseasespecialist from Canada, at the University of Calgary, has developed a triplelayer gel capsule that delivers the microbiota. The triple layer prevents thebreakdown in the stomach. Dr. Thomas hasbeen treating his patients with C. Diff successfully.
PediatricFecal TransplantWhen conducting Fecal Microbiota Transplant in children, it isrecommended to start by administering or placing a temporary nasal gastrictube. (Russell, Kaplan, Ferraro, & Michelow, 2010) FMT has becomepopular within pediatric practitioner, patients, and parents. Fecal microbiota transplantis popular with parents because it helps reduce large amounts of prescribedmedication the children must take due to Clostridium difficile infection or aninflammatory bowel disease and gives the option to decrease the long use of thosemedications. According the World JournalGastroenterology, only 45 pediatric patients have been treated for recurrent Clostridiumdifficile infection, and 27 patients with pediatric Inflammatory Bowel Disease. FMT trials are still in process and currentlyrecruiting pediatric patients.
(Wang, Popov, & Pai, 2016)PossibleBenefits of Fecal Transplant in the Obese Population Obesity is the result ofimbalance between components taken by the body and the lack of energy use. Obesity is associated with the decrease ofintestinal barrier function and developing gut inflammation and metabolicendotoxemia that can lead to systemic oxidative stress and chronic low-gradeinflammation. Mice and humans have asimilar gut metagenome, mice are tested by inducing obesity and use the mice asa model for human studies. Commensalbacteria, the gut epithelial, and lymphoid tissue gives essential and adaptiveimmune defenses to pathogens, antigens, and enables fermentation ofcarbohydrates. Obese-prone rats have agut microbiota that is different from an obese resistant rat. The obese rat microbiome has a greatercapacity to harvest energy.
One study showed, Fecal transplant conducted on alean rat with the obese rat’s feces, increased of body fat percentage in thelean rat’s body. Also, fecal transplantconducted in the obese rat with the lean rat’s feces, showed a decrease in the obeserat’s body fat percentage. (Kulecka, et al., 2016) Interruptionof the gut microbiota is an active contributor for the development of obesityand insulin resistance. The regular, longterm consumption of low dose, low calorie sweeteners is known to influence themicrobiota that may predispose susceptible individuals to insulin resistance.
(Nettleton, Reimer, & Shearer, 2016) Sucralose, aspartameand saccharin, are used to reduce energy content in foods and beverages toencourage weight loss, but has been shown to disrupt the balance and diversityof gut microbiota. (Nettleton, Reimer, & Shearer, 2016)