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粪便微生物群移植治疗复发性艰难梭菌感染:经验、方案及结果

Fecal microbiota transplantation for recurrent Clostridium difficile infection: Experience, protocol, and results.

作者信息

Reigadas E, Olmedo M, Valerio M, Vázquez-Cuesta S, Alcalá L, Marín M, Muñoz P, Bouza E

机构信息

Elena Reigadas Ramírez, Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario "Gregorio Marañón" C/ Dr. Esquerdo, 46, 28007 Madrid, Spain.

Emilio Bouza Santiago, Instituto de Investigación Sanitaria Gregorio Marañón, C/ Dr. Esquerdo, 46,28007 Madrid, Spain.

出版信息

Rev Esp Quimioter. 2018 Oct;31(5):411-418. Epub 2018 Sep 14.


DOI:
PMID:30221898
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6194865/
Abstract

OBJECTIVE: Fecal microbiota transplantation (FMT) is a highly effective therapy for recurrent Clostridium difficile infection (R-CDI). Despite its excellent efficacy, it is still not a routine procedure in most European centers. FMT has not been widely used in Spain to date. We describe our experience with FMT, including a novel approach based on oral fecal capsules. METHODS: We analyzed a prospectively recorded case series of patients with R-CDI treated with FMT at a single center (June 2014-July 2017). Primary outcome was defined as resolution of CDI without recurrence in a two-month period. FMT was administered via colonoscopy, nasojejunal tube, or oral capsules. All stool donors were rigorously screened. RESULTS: FMT was performed in 13 patients with R-CDI. Median age was 75.0 years and 76.9% were females. Six FMT were performed via nasojejunal tube, 5 via oral capsules, and 2 by colonoscopy. There were no procedure-related adverse events, except for bacteremia in one patient. During follow-up, R- CDI was observed in one patient at one month after FMT. The primary resolution rate was 83.3% and the overall resolution rate was 91.7%. FMT by capsules achieved a 100% resolution rate, colonoscopy 100%, and nasojejunal tube 80.0%. CONCLUSIONS: In our cohort, FMT proved to be safe and effective, even in high risk patients. Oral administration in capsules also proved to be safe, well-tolerated, and highly effective for R-CDI. In our experience, the FMT capsule formulation seems feasible in the routine of a hospital. This administration method will allow FMT to be more widely used.

摘要

目的:粪菌移植(FMT)是复发性艰难梭菌感染(R-CDI)的一种高效治疗方法。尽管其疗效卓越,但在大多数欧洲中心仍非常规治疗手段。迄今为止,FMT在西班牙尚未得到广泛应用。我们描述了我们在FMT方面的经验,包括一种基于口服粪胶囊的新方法。 方法:我们分析了在单一中心(2014年6月至2017年7月)接受FMT治疗的R-CDI患者的前瞻性记录病例系列。主要结局定义为在两个月内CDI得到缓解且无复发。FMT通过结肠镜检查、鼻空肠管或口服胶囊给药。所有粪便供体均经过严格筛查。 结果:对13例R-CDI患者进行了FMT。中位年龄为75.0岁,76.9%为女性。6次FMT通过鼻空肠管进行,5次通过口服胶囊进行,2次通过结肠镜检查进行。除1例患者发生菌血症外,未发生与操作相关的不良事件。在随访期间,1例患者在FMT后1个月出现R-CDI。主要缓解率为83.3%,总体缓解率为91.7%。胶囊给药的FMT缓解率为100%,结肠镜检查为100%,鼻空肠管为80.0%。 结论:在我们的队列中,FMT被证明是安全有效的,即使在高危患者中也是如此。口服胶囊给药也被证明对R-CDI是安全、耐受性良好且高效的。根据我们的经验,FMT胶囊制剂在医院常规应用中似乎是可行的。这种给药方法将使FMT得到更广泛的应用。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/68e3/6194865/0c9243322114/revespquimioter-31-411-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/68e3/6194865/123bd8fb2f4e/revespquimioter-31-411-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/68e3/6194865/0c9243322114/revespquimioter-31-411-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/68e3/6194865/123bd8fb2f4e/revespquimioter-31-411-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/68e3/6194865/0c9243322114/revespquimioter-31-411-g002.jpg

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Therap Adv Gastroenterol. 2025-2-8

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[3]
Real-world Use of Bezlotoxumab and Fecal Microbiota Transplantation for the Treatment of Infection.

Open Forum Infect Dis. 2023-1-25

[4]
New Procedure to Maintain Fecal Microbiota in a Dry Matrix Ready to Encapsulate.

Front Cell Infect Microbiol. 2022

[5]
Systematic review with meta-analysis: encapsulated faecal microbiota transplantation - evidence for clinical efficacy.

Therap Adv Gastroenterol. 2021-8-31

[6]
Fecal Microbiota Transplantation for Recurrent Infection in Patients With Multiple Comorbidities: Long-Term Safety and Efficacy Results From a Tertiary Care Community Hospital.

Gastroenterology Res. 2020-8

[7]
Recommendations for the diagnosis and treatment of Clostridioides difficile infection: An official clinical practice guideline of the Spanish Society of Chemotherapy (SEQ), Spanish Society of Internal Medicine (SEMI) and the working group of Postoperative Infection of the Spanish Society of Anesthesia and Reanimation (SEDAR).

Rev Esp Quimioter. 2020-4

本文引用的文献

[1]
Effect of Oral Capsule- vs Colonoscopy-Delivered Fecal Microbiota Transplantation on Recurrent Clostridium difficile Infection: A Randomized Clinical Trial.

JAMA. 2017-11-28

[2]
Faecal microbiota transplantation for <em>Clostridium difficile</em>-associated diarrhoea: a systematic review of randomised controlled trials.

Med J Aust. 2017-8-21

[3]
Is frozen fecal microbiota transplantation as effective as fresh fecal microbiota transplantation in patients with recurrent or refractory Clostridium difficile infection: A meta-analysis?

Diagn Microbiol Infect Dis. 2017-8

[4]
Current challenges in the treatment of severe infection: early treatment potential of fecal microbiota transplantation.

Therap Adv Gastroenterol. 2017-4

[5]
Results of the implementation of a multidisciplinary programme of faecal microbiota transplantation by colonoscopy for the treatment of recurrent Clostridium difficile infection.

Gastroenterol Hepatol. 2017-11

[6]
Successful Resolution of Recurrent Clostridium difficile Infection using Freeze-Dried, Encapsulated Fecal Microbiota; Pragmatic Cohort Study.

Am J Gastroenterol. 2017-6

[7]
Bezlotoxumab for Prevention of Recurrent Clostridium difficile Infection.

N Engl J Med. 2017-1-26

[8]
Fecal microbiota transplant in patients with Clostridium difficile infection: A systematic review.

J Trauma Acute Care Surg. 2016-10

[9]
Oral, frozen fecal microbiota transplant (FMT) capsules for recurrent Clostridium difficile infection.

BMC Med. 2016-9-9

[10]
Gut microbiome predictors of treatment response and recurrence in primary Clostridium difficile infection.

Aliment Pharmacol Ther. 2016-10

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