Division of Gastroenterology, Department of Medicine, Moses Division of Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10467, USA.
J Clin Gastroenterol. 2010 Sep;44(8):562-6. doi: 10.1097/MCG.0b013e3181dac035.
Over the past 20 years, Clostridium difficile has emerged as an important microbial cause of nosocomial diarrhea. Recurrence is common and management of recurrent disease is not standardized. In this case series, we describe 12 patients with refractory/recurrent C. difficile-associated disease (CDAD) treated at our institution by transplantation of donated stool via colonoscopy.
This is a retrospective study of 12 consecutive patients with refractory/recurrent C. difficile infection evidenced by recurrent symptoms and a history of a positive fecal C. difficile toxin assay that were treated by transplantation of donated stool administered during colonoscopy.
Our cohort comprised 9 women and 3 men with a mean age of 66 years (range 30 to 86 y). Nine of the 12 patients had diverticulosis. Patients were symptomatically ill for 79 to 1532 days (mean 351 d, median 209 d) before fecal transplantation. The index infection for which antibiotics was prescribed varied widely along with the inciting antibiotic. All 12 patients (100%) experienced an immediate and durable clinical response to fecal transplantation. There were no adverse side effects from fecal transplantation.
Fecal transplantation via colonoscopy is a safe, effective treatment regimen for refractory/recurrent CDAD. Our 12 patients had an immediate and durable response rate of 100%. Fecal transplantation is a promising treatment for refractory/recurrent C. difficile infection. Its use and efficacy should be pursued in prospective controlled trials.
在过去的 20 年中，艰难梭菌已成为医院获得性腹泻的重要微生物病因。该病复发较为常见，且其复发后的管理尚未标准化。在本病例系列研究中，我们通过结肠镜下捐赠粪便移植的方式，治疗了我院 12 例复发性/难治性艰难梭菌相关疾病（CDAD）患者，并对其进行了描述。
这是一项回顾性研究，纳入了 12 例连续的复发性/难治性艰难梭菌感染患者，这些患者的诊断依据为反复出现症状和粪便艰难梭菌毒素检测阳性，且对复发性艰难梭菌感染采用了结肠镜下捐赠粪便移植的治疗方法。
本队列包括 9 名女性和 3 名男性，平均年龄为 66 岁（范围 30 至 86 岁）。12 例患者中有 9 例患有憩室病。在接受粪便移植前，患者的症状持续时间为 79 至 1532 天（平均 351 天，中位数 209 天）。所使用的抗生素种类和引发该病的抗生素均有较大差异。所有 12 例患者（100%）在接受粪便移植后即刻出现并持续持久的临床应答。粪便移植未引起任何不良反应。
通过结肠镜下进行粪便移植是治疗复发性/难治性 CDAD 的一种安全、有效的治疗方案。我们的 12 例患者的即时和持久应答率为 100%。粪便移植是治疗复发性/难治性艰难梭菌感染的一种很有前景的治疗方法。应在前瞻性对照试验中进一步研究其应用和疗效。
