Tvede M, Rask-Madsen J
Department of Clinical Microbiology, Rigshospitalet, Statens Seruminstitut, Denmark.
Lancet. 1989 May 27;1(8648):1156-60. doi: 10.1016/s0140-6736(89)92749-9.
Six patients with chronic relapsing diarrhoea caused by Clostridium difficile were treated with rectal instillation of homologous faeces (one patient) or a mixture of ten different facultatively aerobic and anaerobic bacteria diluted in sterile saline (five patients). The mixture led to a prompt loss of Cl difficile and its toxin from the stools and to bowel colonisation by Bacteroides sp, which had not been present in pre-treatment stool samples. Strains of Escherichia coli, Cl bifermentans, and Peptostreptococcus productus in the mixture inhibited the in-vitro growth of Cl difficile, which in turn inhibited the growth of Bacteroides ovatus, Bacteroides vulgatus, and Bacteroides thetaiotaomicron. The finding that Bacteroides sp had been absent during the patients' illness but was present after recovery suggests that the absence of Bacteroides sp may result in chronic relapsing Cl difficile diarrhoea, and that its presence may prevent colonisation by Cl difficile.
6例由艰难梭菌引起的慢性复发性腹泻患者接受了以下治疗：1例患者采用同源粪便直肠滴注，5例患者采用在无菌盐水中稀释的10种不同兼性需氧菌和厌氧菌的混合物。该混合物导致粪便中艰难梭菌及其毒素迅速消失，并使拟杆菌属在肠道定植，而这些拟杆菌在治疗前的粪便样本中并不存在。混合物中的大肠杆菌、双发酵梭菌和产肽链球菌菌株抑制了艰难梭菌的体外生长，而艰难梭菌又反过来抑制了卵形拟杆菌、普通拟杆菌和多形拟杆菌的生长。患者患病期间不存在拟杆菌属但康复后存在这一发现表明，拟杆菌属的缺失可能导致慢性复发性艰难梭菌腹泻，而其存在可能阻止艰难梭菌定植。
