aDepartment of Internal Medicine, Division of Infectious Diseases bDepartment of Microbiology & Immunology, The University of Michigan, Ann Arbor, Michigan, USA.
Curr Opin Gastroenterol. 2013 Nov;29(6):628-32. doi: 10.1097/MOG.0b013e328365d326.
The use of faecal microbiota transplantation (FMT) as treatment for recurrent Clostridium difficile infection (CDI) has increased rapidly over the past few years. In this review, we highlight clinical studies of FMT for treatment of recurrent CDI and discuss the safety, standardization and future of this treatment option. The major risk factor for CDI is prior antibiotic use, which results in an altered state of the gut microbiota characterized by decreased microbial diversity. This altered gut microbiota increases the patient's susceptibility to CDI. In patients with recurrent CDI, the microbiota remains in a state with decreased diversity, and FMT from a healthy individual restores the gut microbiota and subsequently colonization resistance against the pathogen.
Recent studies have shown the success rate for FMT as treatment for recurrent CDI being greater than 90%. Standardized, frozen preparations of faeces can be used, which increases the availability of faeces for FMT and decreases the cost of screening individual donors. In addition, there have been recent advances in identifying a defined microbial community isolated from faeces that can restore colonization resistance against C. difficile.
The use of FMT is a successful treatment for recurrent CDI when primary treatment options have failed. However, more work needs to define potential long-term consequences of this treatment and understand how specific members of the gut microbiota can restore colonization resistance against C. difficile.
粪菌移植（FMT）作为复发性艰难梭菌感染（CDI）的治疗方法，在过去几年中迅速得到普及。本文重点介绍了 FMT 治疗复发性 CDI 的临床研究，并讨论了该治疗方法的安全性、标准化和未来前景。CDI 的主要危险因素是既往使用抗生素，这会导致肠道微生物群发生改变，表现为微生物多样性减少。这种改变的肠道微生物群增加了患者发生 CDI 的易感性。在复发性 CDI 患者中，微生物群仍处于多样性减少的状态，来自健康个体的 FMT 可恢复肠道微生物群，并随后对病原体产生定植抵抗。
最近的研究表明，FMT 治疗复发性 CDI 的成功率大于 90%。可以使用标准化、冷冻的粪便制剂，这增加了 FMT 所需粪便的可用性，并降低了筛查个体供体的成本。此外，最近在鉴定可恢复对艰难梭菌定植抵抗的粪便中分离出的特定微生物群落方面取得了进展。
当主要治疗方案失败时，FMT 是治疗复发性 CDI 的有效方法。然而，还需要做更多的工作来定义这种治疗的潜在长期后果，并了解肠道微生物群的特定成员如何恢复对艰难梭菌的定植抵抗。
