Rao Krishna, Safdar Nasia
Division of Infectious Diseases, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan.
Division of Infectious Diseases, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan.
J Hosp Med. 2016 Jan;11(1):56-61. doi: 10.1002/jhm.2449. Epub 2015 Sep 7.
Clostridium difficile, a major cause of healthcare-associated diarrhea due to perturbation of the normal gastrointestinal microbiome, is responsible for significant morbidity, mortality, and healthcare expenditures. The incidence and severity of C difficile infection (CDI) is increasing, and recurrent disease is common. Recurrent infection can be difficult to manage with conventional antibiotic therapy. Fecal microbiota transplantation (FMT), which involves instillation of stool from a healthy donor into the gastrointestinal tract of the patient, restores the gut microbiome to a healthy state. FMT has emerged as a promising new treatment for CDI. There are limited data on FMT for treatment of primary CDI, but FMT appears safe and effective for recurrent CDI. The safety and efficacy of FMT in patients with severe primary or severe recurrent CDI has not been established. Patients with inflammatory bowel disease (IBD) who undergo FMT for CDI may be at increased risk of IBD flare, and caution should be exercised with use of FMT in that population. The long-term safety of FMT is unknown; thus, rigorously conducted prospective studies are needed.
艰难梭菌是医疗保健相关腹泻的主要病因，由于正常胃肠道微生物群受到干扰，它会导致严重的发病率、死亡率和医疗保健支出。艰难梭菌感染（CDI）的发病率和严重程度正在上升，复发性疾病很常见。传统抗生素疗法难以治疗复发性感染。粪便微生物群移植（FMT），即将健康供体的粪便注入患者胃肠道，可使肠道微生物群恢复到健康状态。FMT已成为一种有前景的CDI新疗法。关于FMT治疗原发性CDI的数据有限，但FMT对复发性CDI似乎安全有效。FMT在严重原发性或严重复发性CDI患者中的安全性和有效性尚未确立。因CDI接受FMT的炎症性肠病（IBD）患者可能有更高的IBD发作风险，在该人群中使用FMT应谨慎。FMT的长期安全性尚不清楚；因此，需要进行严格的前瞻性研究。
