Aix Marseille Université, CNRS, IRD, INSERM, AP-HM, URMITE, IHU Méditerranée Infection.
Département Universitaire de Médecine Générale, Aix Marseille Université, AP-HM, Marseille, France.
Clin Infect Dis. 2018 Feb 10;66(5):645-650. doi: 10.1093/cid/cix762.
Severe Clostridium difficile infections (CDIs) are associated with a high mortality rate despite medical and/or surgical treatment. Fecal microbiota transplantation (FMT) prevents recurrences, but its effect on survival has been shown only in patients with O27 ribotype CDI. Here, we investigated whether early FMT could improve survival in hospitalized CDI patients, particularly those with severe infection.
We performed a retrospective cohort study between May 2013 and April 2016 at the infectious diseases department of the North University Hospital of Marseille, France. Patients received either medical treatment alone or treatment with early FMT. The primary outcome was the 3-month mortality rate.
A total of 111 patients were included: 66 in the FMT group and 45 in the non-FMT group. No patient underwent surgery. The O27 ribotype (odds ratio [OR], 3.64 [95% confidence interval {CI}, 1.05- 12.6], P = .04), severe CDI (OR, 9.62 [95% CI, 2.16-42.8], P = .003), and FMT (OR, 0.13 [95% CI, .04-.44], P = .001) were independent predictors of 3-month mortality. FMT improved survival in severe cases (OR, 0.08 [95% CI, .016-.34], P = .001) but not in nonsevere cases (OR, 1.07 [95% CI, .02-56.3], P = .97), independent of age, sex, comorbidities (Charlson score), and ribotype. The number of severe patients who needed to be treated to save 1 life at 3 months was 2.
Early FMT dramatically reduces mortality and should be proposed as a first-line treatment for severe CDI. Further studies are needed to clarify complications and contraindications. Surgery should be reassessed in this context.
尽管进行了医学和/或手术治疗，严重的艰难梭菌感染（CDI）仍与高死亡率相关。粪便微生物群移植（FMT）可预防复发，但仅在 O27 核糖体型 CDI 患者中显示其对生存的影响。在这里，我们研究了早期 FMT 是否可以改善住院 CDI 患者的生存率，特别是那些患有严重感染的患者。
我们在法国马赛北方大学医院传染病科进行了一项回顾性队列研究，时间为 2013 年 5 月至 2016 年 4 月。患者接受单独的药物治疗或早期 FMT 治疗。主要结局是 3 个月死亡率。
共纳入 111 例患者：FMT 组 66 例，非 FMT 组 45 例。没有患者接受手术。O27 核糖体型（比值比[OR]，3.64[95%置信区间{CI}，1.05-12.6]，P =.04）、严重 CDI（OR，9.62[95% CI，2.16-42.8]，P =.003）和 FMT（OR，0.13[95% CI，0.04-0.44]，P =.001）是 3 个月死亡率的独立预测因素。FMT 改善了严重病例的生存率（OR，0.08[95% CI，0.016-0.34]，P =.001），但对非严重病例无影响（OR，1.07[95% CI，0.02-56.3]，P =.97），与年龄、性别、合并症（Charlson 评分）和核糖体型无关。需要治疗的严重患者数量为 2 例，以挽救 1 例患者的生命。
早期 FMT 可显著降低死亡率，应作为严重 CDI 的一线治疗方法。需要进一步研究以明确并发症和禁忌症。在这种情况下，应重新评估手术。
