Furuya-Kanamori Luis, Doi Suhail A R, Paterson David L, Helms Stefan K, Yakob Laith, McKenzie Samantha J, Garborg Kjetil, Emanuelsson Frida, Stollman Neil, Kronman Matthew P, Clark Justin, Huber Charlotte A, Riley Thomas V, Clements Archie C A
*Research School of Population Health, The Australian National University, Canberra, ACT ‡UQ Centre for Clinical Research §School of Medicine, The University of Queensland, Herston ∥∥Faculty of Health Sciences and Medicine, Bond University, Gold Coast ¶Institute for Teaching and Learning Innovation, The University of Queensland, St. Lucia, Qld ¶¶Microbiology & Immunology, The University of Western Australia ##Department of Microbiology, PathWest Laboratory Medicine, Queen Elizabeth II Medical Centre, Nedlands, WA, Australia †College of Medicine, Qatar University, Doha, Qatar ∥London School of Hygiene and Tropical Medicine, Department of Disease Control, London, UK #Department of Medicine, Sørlandet Hospital HF, Kristiansand **Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway ††Department of Internal Medicine, Skaraborgs Hospital, Skovde, Sweden ‡‡East Bay Center for Digestive Health, Oakland, CA §§Department of Pediatrics, Division of Infectious Diseases, University of Washington, Seattle, WA.
J Clin Gastroenterol. 2017 Feb;51(2):145-150. doi: 10.1097/MCG.0000000000000511.
The aim of this study was to compare upper gastrointestinal (UGI) versus lower gastrointestinal (LGI) delivery routes of fecal microbiota transplantation (FMT) for refractory or recurrent/relapsing Clostridium difficile infection (CDI).
FMT has been proven to be a safe and highly effective therapeutic option for CDI. Delivery, however, could be via the UGI or LGI routes, and it is unclear as to which route provides better clinical outcome.
A systematic search for studies that reported the use of FMT for CDI treatment was conducted. Individual patient data that included demographic (age and sex) and clinical (route of FMT delivery, CDI outcome after FMT, and follow-up time) information were obtained. Kaplan-Meier cumulative hazard curves and Cox proportional hazard models were used to assess clinical failure after FMT by the route of delivery.
Data from 305 patients treated with FMT (208 via LGI route and 97 via UGI route) for CDI were analyzed. At 30 and 90 days, the risk of clinical failure was 5.6% and 17.9% in the UGI group compared with 4.9% and 8.5% in the LGI delivery route group, respectively. A time-varying analysis suggested a 3-fold increase in hazard of clinical failure for UGI delivery (hazard ratio, 3.43; 95% confidence interval, 1.32-8.93) in the period after 30 days.
FMT delivered via the LGI seems to be the most effective route for the prevention of recurrence/relapse of CDI. A randomized controlled trial is necessary to confirm whether FMT delivered via the LGI is indeed superior to that delivered via the UGI route.
本研究旨在比较粪便微生物群移植（FMT）治疗难治性或复发性艰难梭菌感染（CDI）时上消化道（UGI）与下消化道（LGI）给药途径的效果。
FMT已被证明是治疗CDI的一种安全且高效的治疗选择。然而，给药途径可以是UGI或LGI，目前尚不清楚哪种途径能带来更好的临床结果。
对报告使用FMT治疗CDI的研究进行了系统检索。获取了包括人口统计学（年龄和性别）和临床（FMT给药途径、FMT后CDI结局及随访时间）信息的个体患者数据。采用Kaplan-Meier累积风险曲线和Cox比例风险模型，按给药途径评估FMT后的临床失败情况。
分析了305例接受FMT治疗CDI患者的数据（208例通过LGI途径，97例通过UGI途径）。在30天和90天时，UGI组临床失败风险分别为5.6%和17.9%，而LGI给药途径组分别为4.9%和8.5%。时变分析表明，在30天后的时间段内，UGI给药的临床失败风险增加了3倍（风险比，3.43；95%置信区间，1.32 - 8.93）。
通过LGI进行FMT似乎是预防CDI复发/再发的最有效途径。有必要进行一项随机对照试验，以确认通过LGI进行的FMT是否确实优于通过UGI途径进行的FMT。
