Gastroenterology and Hepatology, Yeungnam University College of Medicine, Daegu, Korea.
Digestive Disease Institute, Virginia Mason Medical Center, Seattle, USA.
Adv Ther. 2019 Aug;36(8):2052-2061. doi: 10.1007/s12325-019-00974-x. Epub 2019 Jun 1.
Fecal microbiota transplantation resolves recurrent Clostridium difficile infections in greater than 82% of patients. Highly screened, processed universal donor fecal material is available. We compared cost and scheduling efficiency of fecal microbiota transplantation by universal donors to patient-directed donors.
Medical records from a prospectively maintained database of recurrent C. difficile patients who underwent fecal microbiota transplantation between 2012 and 2017 were reviewed retrospectively. Patient-directed donor stool was prepared in our microbiology laboratory using protocol-based screening. We transitioned to purchasing and using universal donor fecal material in 2015. Clinical outcomes, adverse events, time between consult to infusion, consultation fees, and material costs were compared. This was a retrospective comparison of two historical cohorts.
A total of 111 fecal microbiota transplantations were performed on 105 patients (56 from patient-directed donors and 55 from universal donors). Median recipient age was 66 years (18-96) with male to female ratio of 1:2.7, equivalent in both cohorts. Total consultation fees were significantly lower in the universal donor group owing to fewer infectious disease consultations. Costs for donor screening and stool preparation were lower in the universal donor cohort ($485.0 vs. $1189.90 ± 541.4, p < 0.001, 95% CI 559.9-849.9). Time from consultations to infusion was shorter in the universal donor cohort (18.9 ± 19.1 vs. 36.4 ± 23.3 days, p < 0.001, 95% CI 9.521-25.591). Recurrences within 8 weeks after fecal microbiota transplantation were equivalent (p = 0.354). Adverse events were equivalent.
Fecal microbiota transplantation using universal donors versus patient-directed donors for recurrent C. difficile showed comparable efficacy and short-term complications. The use of universal donors resulted in significant cost savings and scheduling efficiency.
粪便微生物群移植在超过 82%的患者中解决了复发性艰难梭菌感染。有经过高度筛选和处理的通用供体粪便材料。我们比较了通用供体和患者定向供体的粪便微生物群移植的成本和安排效率。
回顾性分析了 2012 年至 2017 年间接受粪便微生物群移植的复发性艰难梭菌患者的前瞻性维护数据库中的病历。使用基于方案的筛选，在我们的微生物实验室中制备患者定向供体粪便。我们于 2015 年开始购买和使用通用供体粪便材料。比较了临床结果、不良事件、从咨询到输注的时间、咨询费用和材料成本。这是两个历史队列的回顾性比较。
对 105 名患者（56 名来自患者定向供体，55 名来自通用供体）进行了总共 111 次粪便微生物群移植。中位受者年龄为 66 岁（18-96 岁），男女比例为 1:2.7，两个队列中相等。由于传染病咨询次数减少，通用供体组的总咨询费用明显降低。通用供体组的供体筛查和粪便准备费用较低（485.0 美元与 1189.90 ± 541.4 美元，p < 0.001，95%CI 559.9-849.9）。通用供体组从咨询到输注的时间较短（18.9 ± 19.1 天与 36.4 ± 23.3 天，p < 0.001，95%CI 9.521-25.591）。粪便微生物群移植后 8 周内的复发率相当（p = 0.354）。不良事件相当。
使用通用供体与患者定向供体进行复发性艰难梭菌的粪便微生物群移植显示出相当的疗效和短期并发症。使用通用供体可显著节省成本和提高安排效率。
