Faecal Microbiota Transplant Service

The Hon. K.L. VINCENT (15:43): Today I would like to talk about Dr Sam Costello and the Faecal Microbiota Transplantation Service, or stool bank, which is based at The Queen Elizabeth Hospital. The service is currently being used to treat patients with recurrent Clostridium difficile infection.

Yesterday, I was lucky enough to host a briefing in which some MPs and their staff and other interested people were lucky enough to hear Dr Costello talk about the incredible cure rates that they are achieving so far using people’s donor faecal matter to treat Clostridium difficile (CD) infection. CD is the most common cause of healthcare associated diarrhoea and its incidence, and resistance to effective treatment via antibiotics has increased in recent years. This is a bacteria that causes severe diarrhoea, predominantly in patients who have had antibiotics in the past, so it really takes over the bowel in patients who have had their normal native bacteria killed off by antibiotics.

The organism expands into that ecological void, so to speak, so if you can imagine a depopulated forest. It frequently results in hospitalisation and even intensive care, and at worst, people needing their colon surgically removed. The emergence of hyper virulent strains has led to an increase in death and disability associated with CD in recent years. To cure this, the use of stool populated with healthy faecal matter results in a dramatic improvement in patients' gut microbiota. It is quite incredible.

So, what is a stool bank? It is a frozen repository of stool, and we now have one here in Adelaide down at The QEH. Similarly to blood bank donors, potential stool bank donors are screened with tests of both their blood and their stool, as well as interviewed to make sure the donor does not have a disease which could be transmitted via transplantation. If that is all clear, then they freeze the stool after processing and put it into aliquots that are in the freezer. These can then be drawn on later to be used as therapy.

Faecal transplant is the most effective treatment for that condition and there is also research going into using faecal transplant for a number of other conditions such as irritable bowel syndrome, autism, mood disorders, obesity, multiple sclerosis and metabolic syndrome, to name just a few. So far, Dr Costello and his team have treated 36 patients with a CD infection since the service was established in 2013. Since then, 70 patients have been in our trial of faecal transplant for ulcerative colitis, or 73 patients also during that time. Over 100 patients have received faecal transplant either for CD infections or in the trial setting.

It is really quite effective for CD. Once you have had a couple of courses of antibiotics attempting to treat the infection, you have a small chance that subsequent antibiotic treatments will work; these is only around a 20 per cent to 30 per cent success rate. Faecal transplant in that setting will give around an 80 per cent cure rate. People with CD often have such horrible symptoms, such as constant diarrhoea, feeling terrible, being unable to leave the house due to needing to use the toilet so frequently, and so on. After a couple of bouts, people are usually ready to try anything.

With CD, the deficit is really a lack of biological diversity within the gut, so you have lost your native good bacteria, and they provide resistance against the colonisation of pathogens. This really works by replacing that ecosystem and providing resistance to infection with this CD organism. The fact that this is full of bacteria, but good bacteria, is the reason it works. If you had a rainforest and cut it down, and you really need it to regrow, it would not be enough to put the seeds of one or two trees down. You really need to replace the whole ecosystem, and that is exactly what faecal transplant does. There are about 40,000 different bacterial species known to live within the gut, so it is replacing the whole lot with good bacteria.

In the coming weeks I will certainly be having a lot to say about the amazing benefits faecal transplants have and continue to bring to this state. I think when we talk about South Australia needing to become more innovative, this is the type of innovation we need to support, not only because it is innovation in the scientific sense, but it is quite literally saving people's lives. It is far cheaper to treat people with CD using the stool bank than it is via conventional antibiotic treatments or surgical interventions. This is certainly an innovation that Dignity for Disability is happy to continue to support until we see it properly established and funded in South Australia.