Reigadas E, Olmedo M, Valerio M, Vázquez-Cuesta S, Alcalá L, Marín M, Muñoz P, Bouza E
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.
Rev Esp Quimioter. 2018 Oct;31(5):411-418. Epub 2018 Sep 14.
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.
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.
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%.
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.
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。
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。
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%。
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。
