粪便微生物移植在艰难梭菌感染和肝硬化患者中是安全有效的。
Fecal Microbiota Transplantation Is Safe and Effective in Patients With Clostridioides difficile Infection and Cirrhosis.
机构信息
Division of Gastroenterology, Indiana University School of Medicine, Indianapolis, Indiana.
Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.
出版信息
Clin Gastroenterol Hepatol. 2021 Aug;19(8):1627-1634. doi: 10.1016/j.cgh.2020.06.051. Epub 2020 Jul 6.
BACKGROUND & AIMS: Clostridioides difficile infection (CDI) harms a large proportion of patients with cirrhosis. Fecal microbiota transplantation (FMT) is recommended for recurrent CDI, but its effects in patients with cirrhosis have not been established. We performed a multicenter observational study to evaluate the efficacy and safety of FMT for CDI in patients with cirrhosis.
METHODS
We performed a retrospective study of 63 adults with cirrhosis (median model for end-stage liver disease score, 14.5; 24 patients with decompensated cirrhosis) who underwent FMT for CDI from January 2012 through November 2018 at 8 academic centers in the United States, Canada, and Italy. We collected data on patient demographics and characteristics of cirrhosis, CDI, and FMT from medical records and compared differences among patients with different severities of cirrhosis, and FMT successes vs failures at the 8-week follow-up evaluation. We also obtained data on adverse events (AEs) and severe AEs within 12 weeks of FMT.
RESULTS
Patients underwent FMT for recurrent CDI (55 of 63; 87.3%), severe CDI (6 of 63; 9.5%), or fulminant CDI (2 of 63; 3.2%) primarily via colonoscopy (59 of 63; 93.7%) as outpatients (47 of 63; 76.8%). FMT success was achieved for 54 patients (85.7%). Among FMT failures, a higher proportion used non-CDI antibiotics at the time of FMT (44.4% vs 5.6%; P < .001), had Child-Pugh scores of B or C (100% vs 37.7%; P < .001), used probiotics (77.8% vs 24.1%; P = .003), had pseudomembranes (22.2% vs 0; P = .018), and underwent FMT as inpatients (45.5% vs 19%; P = .039), compared with FMT successes. In multivariable analysis, use of non-CDI antibiotics at the time of FMT (odds ratio, 17.43; 95% CI, 2.00-152.03; P = .01) and use of probiotics (odds ratio, 11.9; 95% CI, 1.81-78.3; P = .01) were associated with a greater risk of FMT failure. FMT-related AEs occurred in 33.3% of patients (21 of 63)-most were self-limited abdominal cramps or diarrhea. There were only 5 severe AEs that possibly were related to FMT; none involved infection or death.
CONCLUSIONS
In a retrospective study, we found FMT to be safe and effective for the treatment of CDI in patients with cirrhosis.
背景与目的
艰难梭菌感染（CDI）会对很大一部分肝硬化患者造成损害。粪便微生物群移植（FMT）被推荐用于复发性 CDI，但它在肝硬化患者中的疗效尚未确定。我们进行了一项多中心观察性研究，以评估 FMT 治疗肝硬化患者 CDI 的疗效和安全性。
方法
我们对 2012 年 1 月至 2018 年 11 月期间在美国、加拿大和意大利的 8 个学术中心接受 FMT 治疗的 63 例肝硬化成人（中位终末期肝病模型评分 14.5；24 例失代偿性肝硬化患者）进行了回顾性研究。我们从病历中收集了患者人口统计学和肝硬化、CDI 和 FMT 特征的数据，并比较了不同严重程度肝硬化患者之间的差异，以及 8 周随访评估时 FMT 成功与失败的差异。我们还获得了 FMT 后 12 周内不良事件（AE）和严重 AE 的数据。
结果
患者因复发性 CDI（55/63；87.3%）、严重 CDI（6/63；9.5%）或暴发性 CDI（2/63；3.2%）接受 FMT，主要通过结肠镜检查（59/63；93.7%）作为门诊患者（47/63；76.8%）。54 例患者（85.7%）获得了 FMT 成功。在 FMT 失败的患者中，更高比例的患者在 FMT 时使用了非 CDI 抗生素（44.4% vs 5.6%；P<.001），Child-Pugh 评分 B 或 C（100% vs 37.7%；P<.001），使用了益生菌（77.8% vs 24.1%；P=.003），有伪膜（22.2% vs 0；P=.018），并且作为住院患者接受 FMT（45.5% vs 19%；P=.039），与 FMT 成功相比。多变量分析显示，FMT 时使用非 CDI 抗生素（比值比，17.43；95%CI，2.00-152.03；P=.01）和使用益生菌（比值比，11.9；95%CI，1.81-78.3；P=.01）与 FMT 失败的风险增加相关。63 例患者（33.3%）发生了与 FMT 相关的 AE-大多数是自限性腹痛或腹泻。只有 5 例严重 AE 可能与 FMT 有关；均无感染或死亡。
结论
在一项回顾性研究中，我们发现 FMT 治疗肝硬化患者 CDI 是安全有效的。
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