In a lab on the 4th floor of Hamilton Health Sciences’ McMaster Children’s Hospital (MCH), there’s a very special freezer. Instead of food, it stores pediatric stool samples. That’s right: poop.

The healthy stool samples are used to create a treatment for the recurring gut infection Clostridium difficile, or C. diff, in children when antibiotics haven’t worked. This treatment has become a common procedure in adults but MCH is on the leading edge of using it for children.

Bad bacteria takes over

Our digestive systems are filled with healthy bacteria that help turn food into waste – also called poop, or stool. But sometimes the healthy bacteria get knocked out by antibiotic drugs used to treat an infection elsewhere in the body.

And then bad bacteria like C. diff can take over in the colon and cause diarrhea, fever and cramps. And it can be hard to get rid of.

That’s what happened to nine-year-old Kayleah, who lives in Millville, Nova Scotia with her family. She has a medical condition that can cause seizures and having C. diff only made them worse.

“Kayleah had been admitted to the hospital for another reason and had to be on IV antibiotics,” says her mom, Tanya. “After that, she was in constant discomfort and pain. Once tests showed that she had C. diff, her health care team tried getting rid of it using multiple different antibiotics with minimal success. She spent 14 months with only a brief break in between suffering from the pain and discomfort of C. diff, which triggered her seizures.”

The scoop on poop

Dr. Nikhil Pai, pediatric gastroenterologist at MCH and his team have been studying a treatment method called fecal microbiota transplant (FMT), to treat other conditions that affect children, like ulcerative colitis and Crohn’s disease. But, this method has already been proven to effectively restore healthy bacteria in the digestive system and get rid of the C. diff.

“About a quarter of all kids who get C. difficile will develop recurrence and need multiple rounds of antibiotics,” he says. “Among these kids, the repeat antibiotics don’t necessarily work, are expensive, can be hard on their bodies or put them at risk for other problems. Many of these children would be
candidates for FMT.”

An FMT is just what it sounds like. Doctors take good bacteria from another person’s healthy stool and use an enema or colonoscopy to insert a liquid containing the good bacteria into the infected person’s body.

While treating C. diff with an FMT is available to adults in Canada, Pai says a barrier to making the treatment more widely available for children has been the lack of a dedicated pediatric program. “Up until now, the only way a child could access FMT in Canada was by finding an adult FMT program and asking an adult physician to perform the treatment. A lot of programs closed down during the COVID-19 pandemic and among those that continued, treating kids with adult donor’s stool became a greater risk.”

He says another barrier is having stool from healthy kids. “It’s never ideal treating children with adult stool due to risk factors that could potentially be transferred from an older donor,” says Pai. “However, up until now, adult donors was all that has been available.”

Helping kids across the country

Dr. Pai and his team recognized they had the skills and experience with FMT to help Canadian children struggling with reoccurring C. diff infections. So, with the support of MCH President, Bruce Squires, the Chief of Pediatrics at McMaster University, Dr. Angelo Mikrogianakis, and the Hamilton Health Sciences Foundation, they made MCH the first hospital in Canada to offer this treatment exclusively to children. Additional expertise was provided by Drs. Jeff Pernica, Christine Lee, Paul Moayyedi, and research coordinator, Melanie Wolfe.

“Our stool bank is literally a collection of poop,” says Pai. “Once the waste is separated from the important bits, one bowel movement can make up to ten FMT treatments. The success of this treatment is outstanding. A single treatment is 81 per cent effective and two FMT treatments are 90 to 97 per cent effective in kids. I can see a future where we won’t need to be constantly chasing C. diff with antibiotics anymore.”

In January 2023, Kayleah was the first pediatric patient to get treated at MCH with healthy bacteria from donor stool. She and her family arrived in Hamilton on a Sunday, she had two treatments on Monday and Wednesday, and they flew home to Nova Scotia that Friday. The treatment was life-changing for Kayleah.

“Both my husband and myself were beyond impressed with Dr. Pai and the whole MCH team and how flawlessly everything went,” says Tanya. “It is absolutely amazing to see how this treatment has helped to give our daughter her health and happiness back. The procedure was quick and simple and I hope one day it could be made available at additional hospitals across the country. Overall, we as a family are extremely grateful that the treatment worked.”

Since then, MCH has continued to grow its stool bank and remains open to children seeking FMT across the country. Any child struggling with C. diff can be referred to Dr. Pai and his team for consultation and treatment by their health-care provider.

If a health-care provider is looking to refer a patient, please contact Amber Kirk at 905-521-2100 x73587, or akirk@mcmaster.ca. Interested in becoming a pediatric stool donor? Please contact Fariha Chowdhury at 905-521-2100 x73587 or pailab@mcmaster.ca. nH