C. Diff: Prevent this Deadly Bacterial Infection

Additional Info

• Segment Number: 3
• Audio File: healthy_talk/1522ht2c.mp3
• Featured Speaker: Stephen J. Schrantz, Jr., MD, MA
• Organization: C. Diffense
• Guest Bio: Dr. Stephen J. Schrantz is a board-certified infectious disease physician at NorthShore University HealthSystem. He is also a Clinical Assistant Professor at the University of Chicago Pritzker School of Medicine. Dr. Schrantz received his medical degree from The Chicago Medical School. After completing his residency training in internal medicine and pediatrics at the University of Chicago, he went on to complete a fellowship in infectious disease at the same institution.
  
  His clinical interests include: illness in returning travelers, infection associated with healthcare contact, infections associated with implanted devices, new diagnosis HIV or ongoing care, bone and joint infection, fever of unknown origin, skin and soft tissue infection, and prevention of infection.
  
  He has co-authored many articles pertaining to infectious disease and has been featured on the Chicago news stations, WGN-9, ABC-7, and CBS-2, for his medical expertise.
• Transcription: RadioMD Presents: Healthy Talk | Original Air Date: May 26, 2015
  
  Anti-Aging and Disease Prevention Radio is right here on Radio MD. Here's author, blogger, lecturer and National Medical Media Personality Dr. Michael Smith, M.D. with Healthy Talk.
  
  DR. MIKE: So, let's continue our discussion about C. diff and get into more the prevention of C. diff, which is really going to be the key. Just as a quick review, C. difficile is a bacterial infection. It happens mostly in hospitalized patients who have been on antibiotics and certain procedures. It causes horrific diarrhea and, of course, this is happening in people that are already sick. That's why it can be so devastating.
  
  So, really, prevention is the key. I'm here with Dr. Steven J. Schrantz. He's a Board Certified Infectious Disease Specialist out in Chicago. He's just been all over the media talking about some of the research he's doing in C. diff.
  
  Dr. Schrantz, welcome to Healthy Talk.
  
  DR. SCHRANTZ: Thanks.
  
  DR. MIKE: I went online and researched in Google and I put "fecal transplant" in. I found that there's a Fecal Transplant Foundation. There's people doing in-home fecal transplants for different things. Why don't you explain what you're doing with this as far as treatment for C. diff?
  
  DR. SCHRANTZ: Sure. My colleagues and myself are looking at fecal material transplantation to mostly treat recurrent C. diff. The way we've proceduralized it is to either give it via colonoscopy or to give it by a quick enema at the bedside. Both have shown to be effective. That's one of the things that we are looking at – what's the best way to do this?
  
  Things are really quickly growing in this field. Now companies have been established that are developing products that are mimicking stool or are stool themselves that people are starting to look at in the home to treat recurrent C. diff. The other interesting area is could we be using this technology - technology sounds like a funny word to use for a stool transplant - we are doing that now earlier for treatment rather than just for recurrent. So, we are starting to look at that.
  
  DR. MIKE: But what does it really do? What is the mechanism of action when you transplant the fecal material into a patient? What's going on there?
  
  DR. SCHRANTZ: I think the easiest way to think about it is that we are re-establishing a balance of bacteria in your colon. As we are learning more and more about the body, this is one of the areas that we didn't understand that much about. Now we are beginning to realize that there are over 5000 different species of bacteria in the colon and they are all working together to provide us nutrients and prevent disease. When a lot of them are taken away by the use of antibiotics, we need to think about re-establishing that healthy bacteria in our colon. And that's exactly what we do. We take healthy bacteria from one person and give it to another.
  
  DR. MIKE: The difference between the fecal transplantation and just a probiotic product is the number of healthy bacteria--the number of healthy species, correct? A probiotic might have anywhere between one to seven species but here you are taking just what's naturally in someone's colon. You are getting a balance of all these healthy probiotics. So, that's an interesting treatment. And you're having some success with this initially, right?
  
  DR. SCHRANTZ: Yes, so studies have been done at our institution but also elsewhere and have shown that this is a very effective treatment for C. diff. I don't want to get into it too much, but people are really starting to think about how else we can look at this. What other diseases are being impacted our fecal microbiota?
  
  DR. MIKE: Let's bring this back to C. diff. Dr. Schrantz, when you talk about treatment, you talk about fecal transplant, you talked about enema, colonoscopy. These are all words that people don't like to hear. So, at the end of the day, prevention is obviously going to be a lot easier. What are we doing in the field of C. diff prevention that you think looks really exciting right now?
  
  DR. SCHRANTZ: In the past, all we've had is making sure people wash their hands and trying to limit the amount of antibiotics that people get exposed to. But now we are starting to think even more about how we can robustly prevent C. diff. One of the products that is being invented and being currently studied is a new vaccine product.
  
  We all know vaccines are a fantastic way to prevent disease. Measles, mumps. One of the things that we all get vaccinated for routinely is tetanus. tetanus is Clostridium Tetani, the bacteria that causes that infection. It produces a toxin and it's the toxin that produces tetanus. The way the vaccine is generated there is they take the toxin and they denature it and they give it to you with the hope that your body gives an immune response to that toxin. So, if it ever sees it again, it recognizes it.
  
  We've taken that same idea and we've applied it to its biologic relative, if you will, Clostridium Difficile. There's now a vaccine that's going to stimulate your body's immune response to the toxin. So, if you ever see it, you don't get the disease. This is an ongoing trial. A Phase III trial they say. There are over 200 sites word-wide that are looking at this and we happen to be one of them. We are looking for 15,000 healthy people who are at risk for C. diff to help us understand whether or not this is going to be an effective treatment.
  
  DR. MIKE: Do you see this vaccine being used in the community or is it really just for people who are coming into the hospital and they get the vaccine? Like that's part of their workup now.
  
  DR. SCHRANTZ: I think that's a fantastic question. I think it's hard to know at this time where the best place to use the vaccine is going to be. I can see it easily being used preventatively in patients that are going to be at risk.
  
  We will be able to establish some known risk factors and once we establish those we say, "Okay. You are going to need the vaccine", rather than giving to infants at birth. I don't think it's at that stage. It is certainly something we can target people who are at risk and give them a vaccine that would prevent a serious complication to the hospitalization that might be coming up or that they might be at risk for.
  
  DR. MIKE: Who's eligible for your study?
  
  DR. SCHRANTZ: We are looking at two groups. The first group is people who are over the age of 50, that have been in the hospital at least twice during the last year and have had some antibiotics. The second group of people are people who are planning a major surgical procedure that is going to land them in the hospital for at least three days after the procedure.
  
  Both of those groups are people who are at risk for C. diff. Anybody who has had C. diff, unfortunately, is not eligible for the study. What's unfortunate about it is that those are the people that really know they don't want to get it. So, we are trying to get the word out to let people know that this is a real problem, this is a growing problem and this is something that we are really working hard to find a good preventative strategy to help people stay healthy.
  
  DR. MIKE: You mentioned that this is in Phase III. So, for my listeners this is kind of pre-market research looking for that approval. What is the timeline? If Phase III pans out and you get the results you want, what are we looking at? A year down the line? Two years? Three years?
  
  DR. SCHRANTZ:I think we are looking at two to three years down the line at this point but that's not up to me. I'm just helping out with the study the best I can. The hope is sooner rather than later. I really think this could help a lot of patients.
  
  DR. MIKE: If my listeners are interested in this, where can they go to find out more about this study? Is there a number or a website?
  
  DR. SCHRANTZ: The website people can go to if they are interested in a study is: www.cdiffense.org and if you are in the Chicagoland area you can call us at: 847-570-3558. We can get in touch with you regarding whether or not you'd be able to participate in the study.
  
  DR. MIKE: Well, Dr. Schrantz, we are going to have to leave it there. Thanks for coming on. Awesome work. Please continue what you're doing because we know that this is serious. It's nice to see that we may have a decent prevention down the line. This is Healthy Talk on Radio MD. I'm Dr. Mike. Stay well.
• Length (mins): 10
• Waiver Received: No
• Host: Mike Smith, MD