Blood bikes help to transport urgent faecal transplants to patients across the West Midlands
Dr Victoria McCune
Clinical Scientist, PHE Public Health Laboratory Birmingham
Since 2015 the Shropshire and Staffordshire Blood Bikes have been transporting urgent faecal transplants, from the Public Health England (PHE), Public Health Laboratory Birmingham to patients at hospitals across the West Midlands and beyond. The faecal transplants are used to treat a diarrheal illness caused by a bacterium called Clostridium difficile. Support from the Shropshire and Staffordshire Blood bikes for this treatment programme has enabled wider access to this novel and effective treatment to patients who, without the blood bikes help, may have struggled to access this treatment.
What is Clostridium difficile?
Clostridium difficile bacteria can live in the intestines (also known as the gut). In a healthy person, C. difficile can live amongst normal bacteria of the gut without causing disease. However, if the numbers of normal bacteria in the gut are significantly reduced then the C. difficile can grow and cause infection. Symptoms of infection with C. difficile include diarrhoea (mild to severe), fever, loss of appetite, nausea and abdominal pain. It can also cause life-threatening inflammation of the intestines; however this is a rarer complication.
Treatment of Clostridium difficile infection using antibiotics
When patients report symptoms of diarrhoea and test positive for C. difficile they are treated with antibiotics to kill the C. difficile bacteria. Up to 80% of those patients treated with antibiotics in their first episode of infection respond to treatment. However, in some people (around 20%) diarrhoea returns after stopping the antibiotics, this is called a recurrence. These patients are treated again with antibiotics, but they are at a much higher risk of the infection returning again and again (up to a 60% risk). These patients are often frail and elderly, and have a high risk of mortality with recurrent C. difficile infection.
Treatment of Clostridium difficile infection using faecal transplants
A faecal transplant is a filtered suspension of faeces prepared from a healthy donor which is given to the patient. The normal bacteria in the donor faeces replenish the bacteria which are missing in the gut of the patient. It is thought that these bacteria compete with the C. difficile bacteria for nutrients and prevent it from growing. As the C. difficile is unable to grow it cannot cause the symptoms of infection and the diarrhoea stops. This is a novel treatment for C. difficile infection.
Faecal transplants are very effective in treating recurrent C. difficile infection, curing around 91% of patients. In comparison antibiotics cure only around 30–40% of these patients. Patients usually see improvement in their diarrhoea very quickly, within 24–72 hours after the faecal transplant and go on to have no further episodes of infection. By providing a voluntary delivery service for faecal transplants, the Shropshire and Staffordshire Blood Bikes enable wider patient access across England, which ultimately improves the quality of care for patients with C. difficile infection.