Public Health England, Public Health Laboratory Birmingham, Heart of England NHS Foundation Trust, Heartlands Hospital, Bordesley Green East, Birmingham B5 9SS, UK.
Public Health England, Public Health Laboratory Birmingham, Heart of England NHS Foundation Trust, Heartlands Hospital, Bordesley Green East, Birmingham B5 9SS, UK.
Int J Antimicrob Agents. 2014 Mar;43(3):201-6. doi: 10.1016/j.ijantimicag.2013.10.009. Epub 2013 Nov 9.
Clostridium difficile infection (CDI) remains a major healthcare burden despite recent global falls in its prevalence. The risk of recurrence is high when using antibiotics such as vancomycin, particularly in already recurrent disease. In light of this, new therapy options are being perused, including novel antibiotics such as fidaxomicin, probiotics, intravenous immunoglobulin and faecal transplantation. Faecal transplantation, referred to here as human probiotic infusion (HPI), is attracting an increasing amount of interest from physicians and patients. Its use has been documented in ca. 500 cases for the treatment of CDI, with overall efficacy rates reported to be ca. 91%. The first randomised controlled trial (RCT) demonstrated that HPI was superior to a 14-day course of vancomycin (89% vs. 31%; P<0.001) and reported no deaths or serious adverse events. Safety and patient acceptability are often cited as limitations to the widespread use of this technique. However, data suggest that the short-term safety profile is encouraging, and concerns over patient acceptability are not warranted in the majority of cases. It seems appropriate to treat an infection which is caused by a major disturbance in the gut microbiota with a treatment that reverses this disturbance, rather than antibiotics that may exacerbate the problem. However, to fully understand the role of HPI in the management of CDI, further RCTs are needed with comparator antibiotics such as fidaxomicin and to establish the most efficacious HPI protocol for administration and preparation.
艰难梭菌感染（CDI）尽管在全球范围内的患病率有所下降，但仍然是一个主要的医疗保健负担。使用抗生素（如万古霉素）时，复发的风险很高，特别是在已经反复发作的疾病中。鉴于此，正在探索新的治疗选择，包括新型抗生素，如非达霉素、益生菌、静脉免疫球蛋白和粪便移植。这里提到的粪便移植，称为人益生菌输注（HPI），正受到越来越多的医生和患者的关注。已经有大约 500 例 CDI 治疗的病例记录了其使用，总体疗效率约为 91%。第一项随机对照试验（RCT）表明，HPI 优于 14 天疗程的万古霉素（89%对 31%；P<0.001），并且没有报告死亡或严重不良事件。安全性和患者接受度通常被认为是该技术广泛应用的限制因素。然而，数据表明，短期安全性概况令人鼓舞，并且在大多数情况下，对患者接受度的担忧是没有根据的。用一种可以逆转这种紊乱的治疗方法来治疗由肠道微生物群的重大紊乱引起的感染，而不是用可能加剧问题的抗生素，这似乎是合理的。然而，为了充分了解 HPI 在 CDI 管理中的作用，还需要进一步的 RCT 来比较抗生素，如非达霉素，并为 HPI 的管理和准备确定最有效的方案。
