Cohen Nathaniel A, Livovsky Dan M, Yaakobovitch Shir, Ben Yehoyada Merav, Ben Ami Ronen, Adler Amos, Guzner-Gur Hanan, Goldin Eran, Santo Moshe E, Halpern Zamir, Paz Kalman, Maharshak Nitsan
Department of Internal Medicine B, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
Digestive Diseases Institute, Shaare Zedek Medical Center, Jerusalem, Israel.
Isr Med Assoc J. 2016 Oct;18(10):594-599.
Antibiotic treatment of Clostridium difficile infection (CDI) has a high failure rate. Fecal microbiota transplantation (FMT) has proven very effective in treating these recurrences.
To determine which method of fecal microbiota transplantation (upper or lower gastrointestinal) and which type of donor (a relative or unrelated) is superior.
This is a retrospective analysis of treatment protocols and outcomes in 22 patients with refractory or recurrent CDI who underwent FMT at two Israeli facilities. Each center used a different donor type, stool preparation and method of delivery. The Tel Aviv Sourasky Medical Center used unrelated fecal donors and frozen stool samples and delivered them primarily (92%) via the lower gastrointestinal (GI) tract. Shaare Zedek Medical Center used fresh donor stool of relatives and delivered them primarily (90%) via the upper GI tract.
FMT had an overall 2 month cure rate of 89%. Patients treated with FMT that was executed through the lower GI tract recovered faster from the infection (1.6 ± 1.08 vs. 2.4 ± 1 days for the upper tract, P = 0.03). The results also showed that patients who received lower GI tract FMTs were more likely to be cured of CDI (100% vs. 75% for upper tract FMTs, P = 0.16). Five patients (22%) died of CDI/FMT-unrelated causes and two (10%) died of CDI/FMT-related causes during the study period.
Lower GI tract FMT is a safe and effective treatment for refractory and recurrent CDI, and yields quicker results than upper GI tract FMT.
艰难梭菌感染（CDI）的抗生素治疗失败率很高。粪便微生物群移植（FMT）已被证明在治疗这些复发性感染方面非常有效。
确定哪种粪便微生物群移植方法（上消化道或下消化道）以及哪种供体类型（亲属或非亲属）更具优势。
这是一项对22例难治性或复发性CDI患者的治疗方案和结果的回顾性分析，这些患者在以色列的两个机构接受了FMT。每个中心使用不同的供体类型、粪便制备方法和给药方式。特拉维夫索罗卡医疗中心使用非亲属粪便供体和冷冻粪便样本，并主要（92%）通过下消化道（GI）给药。沙雷兹德克医疗中心使用亲属的新鲜供体粪便，并主要（90%）通过上消化道给药。
FMT的总体2个月治愈率为89%。通过下消化道进行FMT治疗的患者感染恢复得更快（下消化道为1.6±1.08天，上消化道为2.4±1天，P = 0.03）。结果还表明，接受下消化道FMT的患者更有可能治愈CDI（下消化道FMT为100%，上消化道FMT为75%，P = 0.16）。在研究期间，5例患者（22%）死于与CDI/FMT无关的原因，2例患者（10%）死于与CDI/FMT相关的原因。
下消化道FMT是治疗难治性和复发性CDI的一种安全有效的方法，并且比上消化道FMT产生更快的效果。
