The Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Icahn Institute for Genomics & Multiscale Biology, Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York NY, USA.
Inflamm Bowel Dis. 2019 May 4;25(6):969-979. doi: 10.1093/ibd/izy398.
Recurrent and severe Clostridium difficile infections (CDI) are treated with fecal microbiota transplant (FMT). Uncertainty exists regarding FMT effectiveness for CDI with underlying inflammatory bowel disease (IBD) and regarding its effects on disease activity and effectiveness in transferring the donor microbiota to patients with and without IBD.
Subjects with and without IBD who underwent FMT for recurrent or severe CDI between 2013 and 2016 at The Mount Sinai Hospital were followed for up to 6 months. The primary outcome was CDI recurrence 6 months after FMT. Secondary outcomes were (1) CDI recurrence 2 months after FMT; (2) frequency of IBD flare after FMT; (3) microbiota engraftment after FMT; (and 4) predictors of CDI recurrence.
One hundred thirty-four patients, 46 with IBD, were treated with FMT. Follow-up was available in 83 and 118 patients at 6 and 2 months, respectively. There was no difference in recurrence in patients with and without IBD at 6 months (38.7% vs 36.5%; P > 0.99) and 2 months (22.5% vs 17.9%; P = 0.63). Proton pump inhibitor use, severe CDI, and comorbid conditions were predictors of recurrence. Pre-FMT microbiota was not predictive of CDI recurrence. Subjects with active disease requiring medication escalation had reduced engraftment, with no difference in engraftment based on CDI recurrence or IBD endoscopic severity at FMT.
Inflammatory bowel disease did not affect CDI recurrence rates 6 months after FMT. Pre-FMT microbiota was not predictive of recurrence, and microbial engraftment was impacted in those requiring IBD treatment escalation, though not by CDI recurrence or IBD disease severity.
复发性和严重的艰难梭菌感染（CDI）采用粪便微生物群移植（FMT）治疗。对于伴有炎症性肠病（IBD）的 CDI 以及 FMT 对疾病活动的影响及其在有无 IBD 的患者中转移供体微生物群的效果，尚存在不确定性。
2013 年至 2016 年间，西奈山医院对患有复发性或严重 CDI 的 IBD 患者和非 IBD 患者进行了 FMT，随访时间长达 6 个月。主要结局是 FMT 后 6 个月 CDI 的复发。次要结局是（1）FMT 后 2 个月 CDI 的复发；（2）FMT 后 IBD 发作的频率；（3）FMT 后的微生物群定植；以及（4）CDI 复发的预测因素。
134 例患者（46 例有 IBD）接受了 FMT 治疗。分别在 6 个月和 2 个月时可获得 83 例和 118 例患者的随访资料。6 个月时（38.7%对 36.5%；P>0.99）和 2 个月时（22.5%对 17.9%；P=0.63），有 IBD 和无 IBD 的患者的复发率没有差异。质子泵抑制剂的使用、严重的 CDI 和合并症是复发的预测因素。FMT 前的微生物群不能预测 CDI 的复发。需要药物升级治疗疾病活动的患者的定植减少，但 FMT 时 CDI 复发或 IBD 内镜严重程度与定植没有差异。
IBD 并未影响 FMT 后 6 个月 CDI 的复发率。FMT 前的微生物群不能预测复发，在需要 IBD 治疗升级的患者中，微生物定植受到影响，但不受 CDI 复发或 IBD 疾病严重程度的影响。
