一项用于治疗儿童复发性艰难梭菌感染的胃内粪菌移植方案具有疗效好、安全性高且费用低廉的特点。
An Intragastric Fecal Microbiota Transplantation Program for Treatment of Recurrent Clostridium difficile in Children is Efficacious, Safe, and Inexpensive.
机构信息
Section of Gastroenterology, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO; Children's Hospital Colorado, Aurora, CO.
Section of Gastroenterology, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO; Children's Hospital Colorado, Aurora, CO.
出版信息
J Pediatr. 2018 Mar;194:123-127.e1. doi: 10.1016/j.jpeds.2017.10.016. Epub 2017 Dec 1.
OBJECTIVE
To assess the safety, efficacy, and relative expense of a nurse-led fecal microbiota transplantation (FMT) program for the treatment of recurrent Clostridium difficile infection (CDI).
STUDY DESIGN
Retrospective cohort study design in children aged 1-18 years with recurrent CDI. The intervention was an intragastric FMT with stool derived from a donor stool bank. Primary outcome was resolution of diarrhea at 3 months post-transplantation. A secondary analysis compared charge data associated with FMT by intragastric delivery vs administration by colonoscopy or nasoduodenal tube.
RESULTS
A total of 47 intragastric FMT procedures were performed in 42 children (median age 9 years) with recurrent CDI. Response to treatment varied by disease status, with 94% success in previously healthy children, 75% in medically complex children, and 54% in children with inflammatory bowel disease (P = .04). FMT via intragastric delivery showed lower facility and professional charges by 85% and 78% compared with delivery via colonoscopy and radiology-placed nasoduodenal tube, respectively. The use of stool derived from a donor stool bank decreased charges by 49% compared with charges associated with the use of a donor who was a relative.
CONCLUSION
A nurse-led intragastric FMT procedure using stool derived from a donor stool bank is a relatively inexpensive and efficacious treatment for recurrent CDI in children. Intragastric FMT success in children was attenuated by the presence of underlying disease, particularly inflammatory bowel disease.
目的
评估由护士主导的粪便微生物群移植（FMT）方案治疗复发性艰难梭菌感染（CDI）的安全性、疗效和相对费用。
研究设计
对 1-18 岁复发性 CDI 患儿进行回顾性队列研究。干预措施是通过胃内途径给予来自供体粪便库的粪便进行 FMT。主要结局是移植后 3 个月腹泻缓解。二次分析比较了胃内途径给药与结肠镜或经鼻十二指肠管给药的 FMT 相关费用数据。
结果
共对 42 例复发性 CDI 患儿进行了 47 例胃内 FMT 操作（中位年龄为 9 岁）。治疗反应因疾病状态而异，既往健康的患儿成功率为 94%，医疗复杂的患儿为 75%，炎症性肠病患儿为 54%（P=0.04）。与结肠镜和放射科放置的经鼻十二指肠管相比，胃内途径给药的设施和专业费用分别降低了 85%和 78%。与使用亲属来源的粪便相比，使用来自供体粪便库的粪便可降低 49%的费用。
结论
由护士主导的、使用来自供体粪便库的粪便的胃内 FMT 操作是治疗儿童复发性 CDI 的一种相对廉价且有效的方法。儿童胃内 FMT 的成功率因潜在疾病的存在而降低，特别是炎症性肠病。
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