重症感染治疗中的当前挑战:粪便微生物群移植的早期治疗潜力

Current challenges in the treatment of severe infection: early treatment potential of fecal microbiota transplantation.

作者信息

van Beurden Yvette H, Nieuwdorp Max, van de Berg Pablo J E J, Mulder Chris J J, Goorhuis Abraham

机构信息

Department of Gastroenterology and Hepatology, VU University Medical Center, PK 2X 132, De Boelelaan 1118, 1081 HZ Amsterdam, The Netherlands.

Department of Internal Medicine, Academic Medical Center, Amsterdam, The Netherlands Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands.

出版信息

Therap Adv Gastroenterol. 2017 Apr;10(4):373-381. doi: 10.1177/1756283X17690480. Epub 2017 Feb 8.

Abstract

Fecal microbiota transplantation (FMT) is a very effective treatment for recurrent infection (CDI). Less is known about the application of FMT as a curative treatment of severe or complicated CDI. In this review, we present and discuss evidence supporting the curative use of FMT in severe or complicated CDI. We performed a literature search in PubMed and Embase for studies on the curative use of FMT in severe or complicated CDI. In addition, we describe a patient with severe CDI not responding to initial antibiotic treatment, who was successfully treated with curative FMT. We found 23 reports (12 case reports; 11 case series) about FMT as treatment for severe or complicated CDI. The patients described all had severe or complicated CDI, did not respond to conventional CDI antibiotic treatment and received FMT as last resort treatment. Patients were treated with (sequential) FMT, whether or not followed by additional antibiotic treatment for CDI. FMT, with or without additional antibiotic CDI treatment, appears to be a promising curative treatment option in patients with severe and complicated CDI, or only complicated CDI, who do not respond sufficiently to conventional antibiotic treatment. Treatment with FMT should be considered in these patients before proceeding to emergency bowel surgery.

摘要

粪便微生物群移植(FMT)是复发性艰难梭菌感染(CDI)的一种非常有效的治疗方法。关于FMT作为重症或复杂性CDI的根治性治疗方法的应用,人们了解得较少。在本综述中,我们展示并讨论了支持FMT用于重症或复杂性CDI根治性治疗的证据。我们在PubMed和Embase上进行了文献检索,以查找关于FMT用于重症或复杂性CDI根治性治疗的研究。此外,我们描述了一名对初始抗生素治疗无反应的重症CDI患者,该患者通过根治性FMT成功治愈。我们发现了23篇关于FMT作为重症或复杂性CDI治疗方法的报告(12篇病例报告;11篇病例系列)。所描述的患者均患有重症或复杂性CDI,对传统的CDI抗生素治疗无反应,并接受了FMT作为最后的治疗手段。患者接受了(序贯)FMT治疗,无论之后是否接受了针对CDI的额外抗生素治疗。对于重症和复杂性CDI患者或仅复杂性CDI患者,如果对传统抗生素治疗反应不佳,无论是否进行额外的抗生素CDI治疗,FMT似乎都是一种有前景的根治性治疗选择。在这些患者进行急诊肠道手术之前,应考虑使用FMT进行治疗。

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