What is ecological balance?
The gut microbiota consists of at least 1000 different species and the number of microbes is at least 10 times the total number of cells in the body. There is a fine tuned ecological balance between this incredibly large number of microbes in the gut and us- the host. It is of outmost importance for our health and wellbeing that this balance is maintained in an optimal way. The microbes eat a part of what we eat, and this food is called prebiotics. Microbes have different preference for different types of diet, which means that the contents in our food determine the composition of the microbes. Over 300 additives (E-numbers) are allowed in our food and many of these are preservative agents, colors, stabilizers and emulsifiers, which all have – more or less – an influence on the microbial balance. Antibiotics may have an important additional impact on the composition of our microbiota. Antibiotics should be used with great care especially those that lead to diarrhoea e.g. those caused by Clostridium difficile.
What is Clostridium Difficile?
Clostridium difficile (Cd) - is an anaerobic (resistant to air) spore-forming bacterium that colonizes man early in life. The bacterium can produce toxin (poison) - ffa toxin A and B - which are considered to have disease-causing properties. The number of carriers among children is estimated to be 100% of which half or more are colonized with toxin-forming strains without the individuals in question showing symptoms. Cd is considered part of the normal microbiota. Certain conditions - risk factors - make the bacterium more malignant, such as high age, immunosuppressive treatment, prolonged hospitalization, treatment with proton pump inhibitors and antibiotics.
All types of antibiotics that reach the intestine, or broad-spectrum antibiotics, have the potential to disrupt the microbial balance, giving Cd opportunities to grow and cause disease. The symptoms can range from fairly harmless diarrhea to life-threatening conditions. A more aggressive and resistant form of CD is now spread in the US, Canada, Asia and partly in Europe. In line with the increasing use of antibiotics, the number of cases of Cd-related diarrhea has steadily increased. In the United States, more than 3 million cases / year have been reported in recent years, of which about 14,000 people died from the disease. In Sweden, Cd-related diarrhea is not subject to notification, but in 2012 it was estimated to be just under 8000 cases / year.
Treatment
Treatment of Clostridium difficile related diarrhoeas
In mild cases it is mostly sufficient (if possible) to interrupt the antibiotic treatment so the microbial balance in the gut can be restored by itself. In more severe cases the traditional therapy is either metronidazole or vancomycin, but the risk for recurrent infection is about 30%, and after further medication the recurrence rate increases to 50%. The reason for the high recurrence risk is probably that more antibiotics lead to more disturbances in an already imbalanced ecosystem.
Now, a commonly accepted and used alternative treatment is to try to restore the ecosystem and the microbial balance in the gut. This is done by installing intestinal microbes from a healthy donor and the popular term for this procedure is “fecal transplantation”.
There are two types of transplantation
1. Fecal Microbiota Transplant (FMT): The stool from a donor, usually a close relative. Both the donor and the donor feces must undergo a thorough screening to minimize any risk of transferring factors that may cause disease. Alternatively, feces can be used from a so called “feces bank” where a number of donors regularly donate stool. These donors must also go through regular health checks, normally every 4 months. Both alternatives are expensive and time-consuming.
2. ACHIM ”Anaerobically Cultivated Human Intestinal Microbiota” originates from a healthy person who left a stool sample in 1995. The donor fulfilled all the criteria for donors to a feces bank.
Since then the intestinal bacteria from the sample have been cultivated anaerobically under strict conditions. The culture has been tested regularly during the past 20 years, and shown to retain the most dominating microbial groups and most importantly- retained its clinical effect.