Department of Medicine, Tower Health System, Sixth Avenue and Spruce Street, West Reading, PA 19611, USA.
Hospitalist Services, Tower Health System, Sixth Avenue and Spruce Street, West Reading, PA 19611, USA.
Can J Gastroenterol Hepatol. 2018 Sep 2;2018:1394379. doi: 10.1155/2018/1394379. eCollection 2018.
Fecal microbiota transplantation (FMT) has been shown to be effective in recurrent (CD) infection, with resolution in 80% to 90% of patients. However, immunosuppressed patients were often excluded from FMT trials, so safety and efficacy in this population are unknown.
We searched MEDLINE and EMBASE for English language articles published on FMT for treatment of CD infection in immunocompromised patients (including patients on immunosuppressant medications, patients with human immunodeficiency virus (HIV), inherited or primary immunodeficiency syndromes, cancer undergoing chemotherapy, or organ transplant, including-bone marrow transplant) of all ages. We excluded inflammatory bowel disease patients that were not on immunosuppressant medications. Resolution and adverse event rates (including secondary infection, rehospitalization, and death) were calculated.
Forty-four studies were included, none of which were randomized designs. A total of 303 immunocompromised patients were studied. Mean patient age was 57.3 years. Immunosuppressant medication use was the reason for the immunocompromised state in the majority (77.2%), and 19.2% had greater than one immunocompromising condition. Seventy-six percent were given FMT via colonoscopy. Of the 234 patients with reported follow-up outcomes, 207/234 (87%) reported resolution after first treatment, with 93% noting success after multiple treatments. There were 2 reported deaths, 2 colectomies, 5 treatment-related infections, and 10 subsequent hospitalizations.
We found evidence that supports the use of FMT for treatment of CD infection in immunocompromised patients, with similar rates of serious adverse events to immunocompetent patients.
粪便微生物群移植（FMT）已被证明对复发性（CD）感染有效，80%至90%的患者得到缓解。然而，免疫抑制患者经常被排除在 FMT 试验之外，因此该人群的安全性和疗效尚不清楚。
我们搜索了 MEDLINE 和 EMBASE 中以英语发表的关于 FMT 治疗免疫抑制患者（包括接受免疫抑制药物、人类免疫缺陷病毒（HIV）、遗传性或原发性免疫缺陷综合征、正在接受化疗或器官移植的癌症患者，包括骨髓移植）的 CD 感染的文章。我们排除了未接受免疫抑制药物的炎症性肠病患者。计算了缓解率和不良事件发生率（包括继发感染、再住院和死亡）。
共纳入 44 项研究，均非随机设计。共有 303 名免疫抑制患者接受了研究。患者平均年龄为 57.3 岁。大多数（77.2%）免疫抑制状态是由于使用免疫抑制药物，19.2%的患者有多种免疫抑制情况。76%的患者通过结肠镜进行 FMT。在报告了随访结果的 234 名患者中，207/234（87%）在首次治疗后报告缓解，93%的患者在多次治疗后报告成功。有 2 例死亡、2 例结肠切除术、5 例治疗相关感染和 10 例随后住院。
我们发现有证据支持 FMT 用于治疗免疫抑制患者的 CD 感染，严重不良事件发生率与免疫功能正常的患者相似。
