Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Pharmacology, National Yang Ming Chiao Tung University, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
Endoscopy Center for Diagnosis and Treatment, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
J Formos Med Assoc. 2022 Sep;121(9):1636-1646. doi: 10.1016/j.jfma.2021.11.001. Epub 2021 Nov 24.
BACKGROUND/PURPOSE: Clostridium difficile infection (CDI) leads to a significant cause of hospital-acquired morbidity and mortality. Fecal microbiota transplantation (FMT) is effective to treat recurrent or refractory CDI (rCDI). However, the change of microbial composition contributed by FMT and its association with treatment outcomes is not well determined in Taiwan. We aimed to investigate the efficacy of FMT and the association with microbial alteration endemically.
Twelve patients who received FMT for rCDI in Taipei Veterans General Hospital were prospectively enrolled from April 2019 to July 2020. The clinical assessments and fecal microbial analyses in comparison with fecal materials of unrelated donors were conducted before and after FMT.
The overall success rate of FMT for rCDI was 91.7%. A prominence of Proteobacteria, Gammaproteobacteria and Enterobacteriales were observed in the feces of patients with rCDI. Increased fecal phylogenetic diversities and a significant microbial dissimilarity were provided by successful FMT compared to patients before treatment. However, the distinctness was not obvious between patients' feces at baseline and after unsuccessful FMT. Moreover, dynamic change of fecal microbial composition after FMT was observed during follow-up but did not interrupt the treatment effects of FMT.
Gut dysbiosis commonly co-exists in patients with rCDI. Restoration of gut microbial communities by FMT provides a promising strategy to treat antibiotic-failed CDI, and the extent of microbial change would be related to the treatment outcomes of FMT. Besides, the effectiveness of FMT for CDI could be maintained even the gut microbiota has diverged over time.
背景/目的：艰难梭菌感染（CDI）是导致医院获得性发病率和死亡率的重要原因。粪便微生物群移植（FMT）是治疗复发性或难治性 CDI（rCDI）的有效方法。然而，FMT 引起的微生物组成变化及其与治疗结果的关系在台湾尚未得到很好的确定。我们旨在研究 FMT 的疗效及其与本地微生物变化的关系。
2019 年 4 月至 2020 年 7 月，我们前瞻性地招募了 12 名在台北荣民总医院接受 rCDI 治疗的 FMT 患者。在 FMT 前后，我们进行了临床评估和粪便微生物分析，并与无关供体的粪便材料进行了比较。
rCDI 的 FMT 总体成功率为 91.7%。rCDI 患者的粪便中存在大量的变形菌门、γ变形菌纲和肠杆菌目。与治疗前相比，成功的 FMT 提供了更高的粪便系统发育多样性和显著的微生物差异。然而，在治疗失败的患者中，粪便在基线时和 FMT 后的差异并不明显。此外，在随访期间观察到 FMT 后粪便微生物组成的动态变化，但这并没有干扰 FMT 的治疗效果。
rCDI 患者普遍存在肠道菌群失调。FMT 恢复肠道微生物群落为治疗抗生素失败的 CDI 提供了一种有前途的策略，微生物变化的程度与 FMT 的治疗效果有关。此外，即使肠道微生物随时间发生了变化，FMT 治疗 CDI 的有效性也能得以维持。
