Girotra Mohit, Garg Shashank, Anand Rohit, Song Yang, Dutta Sudhir K
Division of Gastroenterology, Department of Medicine, Johns Hopkins University/Sinai Hospital Program in Internal Medicine, Baltimore, MD, USA.
Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, USA.
Dig Dis Sci. 2016 Oct;61(10):3007-3015. doi: 10.1007/s10620-016-4229-8. Epub 2016 Jul 22.
Fecal microbiota transplantation (FMT) has become the cornerstone in management of recurrent Clostridium difficile infection (RCDI) in adults. However, data on efficacy, safety, long-term outcomes, and microbiota alterations are limited in elderly patients (>65 years).
Twenty-nine consecutive elderly patients with RCDI underwent FMT with combined jejunal and colonic method and monitored for long-term outcomes. Fecal samples from five elderly RCDI patients (G65) were subjected to genomic analysis before and after FMT, and microbiota changes were compared with matched RCDI patients below 65 years (L65).
FMT resulted in marked improvement in all clinical parameters, including abdominal pain, bloating, and diarrhea in all elderly RCDI patients. Fecal C. difficile toxin was positive in all 29 patients and turned negative in all 27 patients, who agreed to undergo this test after FMT. Statistically significant improvement in leukocytosis was noted (p < 0.05). Only adverse events reported were transient mild fever (2/29) and bloating (3/29). Long-term follow-up over 25.4 ± 12.8 months did not reveal any additional adverse events or RCDI recurrence. Genomic analysis suggested that overall microbiota diversity increased post-FMT in elderly RCDI patients. However, this response was less robust than the younger group. While Firmicutes did not change markedly, Proteobacteria decreased significantly in post-FMT samples in elderly RCDI patients.
These observations suggest that FMT in elderly patients with RCDI appears to be highly efficacious with no recurrence of infection over long-term follow-up. Alterations in microbiota in this group of patients are characterized by less robust increase in microbial diversity and marked reduction in phylum Proteobacteria.
粪便微生物群移植（FMT）已成为成人复发性艰难梭菌感染（RCDI）管理的基石。然而，关于老年患者（>65岁）的疗效、安全性、长期结局和微生物群改变的数据有限。
29例连续的老年RCDI患者采用空肠和结肠联合方法接受FMT，并对长期结局进行监测。对5例老年RCDI患者（G65）的粪便样本在FMT前后进行基因组分析，并将微生物群变化与65岁以下匹配的RCDI患者（L65）进行比较。
FMT使所有老年RCDI患者的所有临床参数显著改善，包括腹痛、腹胀和腹泻。所有29例患者的粪便艰难梭菌毒素均为阳性，27例同意在FMT后进行此项检测的患者毒素均转为阴性。白细胞增多症有统计学意义的改善（p<0.05）。仅报告的不良事件为短暂性低热（2/29）和腹胀（3/29）。超过25.4±12.8个月的长期随访未发现任何额外不良事件或RCDI复发。基因组分析表明，老年RCDI患者FMT后总体微生物群多样性增加。然而，这种反应不如年轻组强烈。虽然厚壁菌门没有明显变化，但老年RCDI患者FMT后样本中的变形菌门显著减少。
这些观察结果表明，老年RCDI患者的FMT似乎非常有效，长期随访无感染复发。该组患者的微生物群改变的特征是微生物多样性增加不强烈，变形菌门显著减少。
