Gouveia Catarina, Palos Carlos, Pereira Patrícia, Roque Ramos Lídia, Cravo Marília
Gastroenterology Department, Beatriz Ângelo Hospital, Loures, Portugal.
Infection Control and Antimicrobial Resistance Department, Beatriz Ângelo Hospita, Loures, Portugal.
GE Port J Gastroenterol. 2020 Dec;28(1):56-61. doi: 10.1159/000507263. Epub 2020 Aug 19.
There has been a growing interest in fecal microbiota transplantation (FMT) as a way to manipulate gut microbiota, with potential benefit in patients infected with multidrug-resistant (MDR) bacteria.
We present the case of an 87-year-old male with recurrent ascending cholangitis due to biliary atony and impaired biliary drainage after multiple biliary sphincterotomies and two papillary balloon dilations. In this context, a choledochoduodenostomy was performed, but the patient kept on having repeated episodes of acute cholangitis, resulting in multiple hospitalizations, every other week, with need of multiple broad-spectrum antibiotic courses, which led to bacteremias with MDR microorganisms. Several therapeutic strategies such as prophylactic antibiotics (including rifaximin), pre- and probiotics, prokinetics, and ursodeoxycholic acid were unsuccessfully attempted. After multidisciplinary case discussion, an FMT was proposed, with the aim of manipulating gut microbiota and decreasing MDR bacteremias. We first performed FMT via colonoscopy in September 2018, after which the patient still had 3 more hospitalizations for acute cholangitis, but isolated bacteria in blood cultures were resistant only to amoxicillin and clavulanic acid. Considering this apparent change in the microbial resistance profile, we performed a second FMT in January 2019 via the upper gastrointestinal route. During the next 4 months, the patient remained well. In April 2019, the patient relapsed again with three more episodes of cholangitis, for which we repeated the FMT via upper gastrointestinal endoscopy. No readmissions were observed during the next 4 months. All three FMTs were performed without complications.
FMT seems to be a safe procedure and was effective in decreasing hospital admissions and changing the profile of MDR bacteria previously isolated from blood cultures.
粪便微生物群移植（FMT）作为一种调节肠道微生物群的方法，人们对其兴趣与日俱增，它可能对多重耐药（MDR）菌感染的患者有益。
我们报告一例87岁男性患者，因胆道张力缺乏及多次胆管括约肌切开术和两次乳头球囊扩张术后胆道引流受损，反复发生上行性胆管炎。在此情况下，进行了胆总管十二指肠吻合术，但患者仍反复出现急性胆管炎发作，导致每隔一周就需多次住院，并需要多次使用广谱抗生素疗程，这导致了MDR微生物菌血症。尝试了多种治疗策略，如预防性抗生素（包括利福昔明）、益生元、促动力药和熊去氧胆酸，但均未成功。经过多学科病例讨论，提出了FMT，目的是调节肠道微生物群并减少MDR菌血症。我们于2018年9月首次通过结肠镜进行了FMT，此后患者仍因急性胆管炎住院3次，但血培养中分离出的细菌仅对阿莫西林和克拉维酸耐药。考虑到微生物耐药谱的这一明显变化，我们于2019年1月通过上消化道途径进行了第二次FMT。在接下来的4个月里，患者情况良好。2019年4月，患者再次复发，又出现了3次胆管炎发作，为此我们通过上消化道内镜再次进行了FMT。在接下来的4个月里未观察到再次入院情况。所有三次FMT均未出现并发症。
FMT似乎是一种安全的操作，在减少住院次数和改变先前从血培养中分离出的MDR细菌谱方面是有效的。
