Dodin M, Katz D E
Internal Medicine Department, Shaare Zedek Medical Center, Jerusalem, Israel.
Int J Clin Pract. 2014 Mar;68(3):363-8. doi: 10.1111/ijcp.12320. Epub 2013 Dec 22.
To review the current clinical literature regarding the use of fecal microbiota transplantation (FMT) for severe and recurrent Clostridium difficile disease (CDAD).
Clostridium difficile (C. difficile) is a gram positive, spore forming bacteria, and an important nosocomial pathogen causing healthcare associated diarrhoea in hospitalized patients in developed and developing countries. During the past several years, CDAD has become more frequent, severe, refractory, and more likely to relapse. It has become apparent that C. difficile is no longer just a nosocomial infection, with a rising rate of infection in populations not previously affected. Standard treatment regimens and new medications exist, but recurrence rates are high.
Using PubMed, we conducted a Boolean search with the following medical subject headings (MeSH): Clostridium difficile infection and fecal transplantation or recurrent C. difficile infection. We restricted the search to human studies, published in English, between 2011 through June 1, 2013.
There were 104 publications identified. Of those related to FMT, there were 20 clinical reviews, 6 case reports, 3 clinical trials (one, a randomized control trial), and 1 meta-analysis. Since 1958 there have been 36 published reports of FMT for C. difficile infection (CDI) representing 583 patients. Success rates were higher when FMT was administered via colonoscopy (representing the majority of patients, 79.2%). The overall success rate for FMT, regardless of administration method, was 80-98%.
Fecal microbiota transplantation attempts to restore the normal microbiome of the colon, and has achieved a cure rate reaching more than 90%. Mounting evidence supports the utility of FMT for severe and recurrent cases of CDI. Barriers that will need to be addressed are patient perceptions and fears, standard protocol development, and further clinical trials.
回顾目前关于粪便微生物群移植（FMT）用于治疗严重及复发性艰难梭菌病（CDAD）的临床文献。
艰难梭菌是一种革兰氏阳性、形成芽孢的细菌，是发达国家和发展中国家住院患者中引起医疗保健相关腹泻的重要医院病原体。在过去几年中，CDAD变得更加频繁、严重、难治且更易复发。显然，艰难梭菌不再仅仅是一种医院感染，在以前未受影响的人群中感染率也在上升。虽然存在标准治疗方案和新药物，但复发率很高。
我们使用PubMed，通过以下医学主题词（MeSH）进行布尔检索：艰难梭菌感染与粪便移植或复发性艰难梭菌感染。检索范围限于2011年至2013年6月1日期间发表的英文人体研究。
共识别出104篇出版物。其中与FMT相关的有20篇临床综述、6篇病例报告、3项临床试验（一项为随机对照试验）和1篇荟萃分析。自1958年以来，已有36篇关于FMT治疗艰难梭菌感染（CDI）的报告，涉及583例患者。通过结肠镜检查进行FMT时成功率更高（占大多数患者，为79.2%）。无论给药方式如何，FMT的总体成功率为80%-98%。
粪便微生物群移植试图恢复结肠的正常微生物群，治愈率达到90%以上。越来越多的证据支持FMT对严重及复发性CDI病例的效用。需要解决的障碍包括患者的认知和恐惧、标准方案的制定以及进一步的临床试验。
