Shin Jae Hyun, Chaplin Ashley S, Hays R Ann, Kolling Glynis L, Vance Sheila, Guerrant Richard L, Archbald-Pannone Laurie, Warren Cirle A
Department of Medicine, Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA 22903, USA.
Novant Health, Winston-Salem, NC 27103, USA.
J Clin Med. 2019 Jul 16;8(7):1036. doi: 10.3390/jcm8071036.
Fecal microbiota transplantation (FMT) has been shown to be an effective treatment for recurrent infections (rCDIs). We assessed the benefits of a multidisciplinary clinic for screening FMT eligibility in patients with rCDI. Patients seen at the University of Virginia Complicated Clinic (CCDC) underwent comprehensive evaluation for possible FMT. Patients were eligible for FMT if there was history of greater than two episodes of rCDI. Patients were evaluated for the outcome after evaluation in the clinic. A total of 113 patients were evaluated: 77 were eligible for FMT, of which 25 patients did not undergo FMT. The rate of recurrence at three months and all-cause mortality were 4.5% and 7% for patients who received FMT and 16.7% and 12.5% for eligible patients who did not receive FMT. There were 36 patients who were not eligible for FMT, with two or fewer recurrences and a recurrence rate of 8.8% and all-cause mortality of 6%. One in three patients screened for FMT had a nutritional deficiency diagnosed, with zinc deficiency being most common (20%). Additional diagnoses, including inflammatory bowel disease, were made during the evaluation. FMT is a highly effective treatment for rCDI, most notably in patients with multiple recurrences. A systematic approach for evaluating patients with rCDI helps identify patients who benefit most from FMT and those who have other conditions.
粪便微生物群移植（FMT）已被证明是治疗复发性艰难梭菌感染（rCDI）的有效方法。我们评估了多学科诊所对rCDI患者进行FMT资格筛查的益处。在弗吉尼亚大学复杂疾病诊所（CCDC）就诊的患者接受了FMT可能性的全面评估。如果有两次以上rCDI发作史，则患者符合FMT条件。在诊所评估后对患者的结局进行评估。总共评估了113例患者：77例符合FMT条件，其中25例患者未接受FMT。接受FMT的患者三个月时的复发率和全因死亡率分别为4.5%和7%，符合条件但未接受FMT的患者分别为16.7%和12.5%。有36例患者不符合FMT条件，复发次数为两次或更少，复发率为8.8%，全因死亡率为6%。接受FMT筛查的患者中有三分之一被诊断为营养缺乏，其中锌缺乏最为常见（20%）。在评估期间还做出了包括炎症性肠病在内的其他诊断。FMT是治疗rCDI的高效方法，在多次复发的患者中尤为明显。对rCDI患者进行系统评估有助于识别最能从FMT中获益的患者以及患有其他疾病的患者。
