Digestive Diseases Institute, Shaare Zedek Medical Center, Jerusalem, Israel.
Bacteriotherapy Clinic, Department of Gastroenterology and Liver Diseases, Tel Aviv Medical Center, Tel Aviv, Israel.
Dig Dis Sci. 2018 Jan;63(1):198-203. doi: 10.1007/s10620-017-4833-2. Epub 2017 Nov 13.
Fecal microbiota transplantation (FMT) is a new technique recently introduced to treat recurrent Clostridium difficile infection (CDI). Little is known about the efficacy and risks of FMT in elderly and ill patients.
To investigate FMT efficacy in ill and elderly patients compared to conventional treatment.
The study comprised two groups of patients between 2012 and 2016 with recurrent CDI at two medical centers in Israel. The study group received FMT and the controls conventional therapy. The primary end points were CDI recurrence, length of hospitalization, and short-term survival.
Thirty-four patients altogether, (21 females, mean age 82 years) participated, 11 received FMT and 23 controls. Demographics and clinical characteristics were similar between the two groups. Comorbidity indexes, i.e., Charlson index was high in both groups. In the FMT group, 10/11 (90%) patients showed clinical improvement 3 days after initiating treatment compared to 9/23 (39%) in the control group, p = 0.02. Survival at 2 months did not differ between the groups (FMT 54%, Control 50%, p = 0.816), but mean survival in the FMT group was higher than in the control (12 vs. 4 months, respectively, p = 0.015). Two significant adverse events from the FMT group included suspected aspirations, both occurring during gastroscopy route of administration.
FMT is effective for elderly and very ill patients. Safety is a concern, but is rare even in patients with much comorbidity. Colonoscopy may be the preferred route of FMT infusion.
粪便微生物群移植（FMT）是最近引入的一种治疗复发性艰难梭菌感染（CDI）的新技术。关于 FMT 在老年和患病患者中的疗效和风险知之甚少。
研究 FMT 在患病和老年患者中的疗效与传统治疗相比。
本研究包括 2012 年至 2016 年间在以色列的两个医疗中心患有复发性 CDI 的两组患者。研究组接受 FMT，对照组接受常规治疗。主要终点是 CDI 复发、住院时间和短期存活率。
共有 34 名患者（21 名女性，平均年龄 82 岁）参与了研究，其中 11 名接受了 FMT，23 名接受了对照组。两组患者的人口统计学和临床特征相似。两组的合并症指数（即 Charlson 指数）均较高。在 FMT 组中，10/11（90%）患者在开始治疗后 3 天显示出临床改善，而对照组为 9/23（39%），p=0.02。两组患者在 2 个月时的存活率无差异（FMT 54%，对照组 50%，p=0.816），但 FMT 组的平均存活时间高于对照组（分别为 12 个月和 4 个月，p=0.015）。FMT 组有 2 例严重不良事件，包括疑似吸入，均发生在胃镜给药途径时。
FMT 对老年和非常患病的患者有效。安全性是一个问题，但即使在合并症较多的患者中也很少见。结肠镜检查可能是 FMT 输注的首选途径。
