“It was the worst time in my life,” Samar Munoz says of the superbug that ravaged her body.
Daily antibiotics were not strong enough to fight off the Clostridium difficile (C. diff) attacking her guts for nearly 15 years. In January, and then again in May, she found herself fighting for her life in intensive care.
It’s a very, very good idea. It should have been done a long time ago. Professor Thomas Borody
So when doctors at Westmead Hospital offered her the chance to become the first patient in a new treatment for C. diff she knew she had to take part, although she “was a bit iffy” at first.
That’s because the treatment itself was perhaps the most stomach-churning cure for a gut problem you could possibly imagine.
Ms Munoz was to be given a poo transplant.
And not just any poo: her husband, Charles, was to be the donor.
But the results were almost immediate. After years of suffering, Ms Munoz is now cured.
The procedure allows the good bacteria in the transplanted poo to recolonise the body, so the body can fight off the infection.
Westmead Hospital is now setting up a permanent program of poo transplantation, with the hope that patients from across the state will be referred when all else has failed. It will be only the second public hospital in Australia to offer it, even though the Gastroenterological Society of Australia last month recommended all people with recurrent C. diff should get it.
Recently, Fairfax Media understands a young woman in her 30s died of a C. diff infection that attacked her system so quickly and viciously that nothing could be done.
David van der Poorten, a staff specialist in gastroenterology and hepatology at Westmead Hospital and a senior lecturer at Sydney University, said he was setting up a “poo bank” at the hospital, so emergency cases – often caused by severe “superbug” strains that are more common overseas – could be treated.
“In most cases C. diff infection only occurs in people who are sick anyway; the elderly, people with immune problems or cancer, or people who have had a lot of antibiotics,” he said.
“Some of these severe strains seem to be occurring even in people who are relatively healthy.”
More than 4500 people in NSW are infected with C. diff each year, with infections increasing. In 5 per cent of cases antibiotics fail, and sometimes the only treatment is to remove the bowel. If successful, such drastic surgery has huge impacts on the person’s quality of life. But in up to half the cases it fails, and the person dies.
So far four patients have been treated at Westmead and all have been cured. The treatment is believed to have a 90 per cent success rate.
“There’s very few things we do where the success rate is 90 per cent – a treatment that works in 60 per cent of cases is considered an excellent treatment,” Dr van der Poorten said.
He was inspired to start the program at Westmead after a groundbreaking study published in the New England Journal of Medicine found it was an almost universal cure for the deadly C. diff infection, to such an extent that the ethics committee in charge stopped the study early on the grounds it would be unethical not to offer the treatment to all patients.
Yet the only place where the treatment was available was the privately run Centre for Digestive Diseases in Five Dock, which is run by a pioneer of faecal transplant – Australian professor Thomas Borody.
“Most of the patients we have at Westmead don’t have private health insurance and it’s just not feasible for them to pay a couple of thousand dollars,” Dr van der Poorten said. “We had patients who had ended up with bad outcomes who almost certainly would have done better if they had had this treatment. Yet not a single public hospital was offering it.”
An editorial published in the British Medical said Australian health authorities were behind Britain in formalising approval for the treatment.
Dr van der Poorten said part of the difficulty in getting a clinic set up was that hospitals and medical authorities tended not to know how to categorise a poo transplant: as a drug, experimental treatment, or a biological therapy. To get his clinic set up took more than 12 months and required him to do it as part of a new clinical trial.
But this means Dr van der Poorten may now be able to use the trial to explore cutting-edge research into how the bacteria in our guts could influence things such as why some people get overweight while others stay thin.
Researchers believe it could be linked to our individual range of gut bacteria.
“I think eventually it will be proven that if you get the appropriate mix of bacteria from someone who is lean, it does affect things like metabolism,” he said.
This year US doctors reported a case of a healthy-weight patient who received a transplant from her overweight daughter. Within a year and a half, the woman had become obese. Other studies in mice have found similar effects.
Westmead Hospital will only source donations from lean people who have undergone a raft of tests and a full medical history. This would stop people who have, for example, a family history of bowel cancer from donating.
So far every donation besides Mr Munoz’ has come from a gasteroenterology registrar, and Dr van der Poorten expects medical students will make up most future donors.
The donation is simply collected, tested, then blended with saline solution in a normal household blender, and inserted via colonoscopy.
Professor Borody said he welcomed the new clinic. “I think it’s a very, very good idea,” he said. “It should have been done a long time ago. It’s about time this was in the public system.”
And Ms Munoz says anyone suffering like she was should jump at the treatment.
“Just do it, do it, do it, do it,” she says. “It’s unbelievable.”