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粪便微生物群移植治疗复发性肠道艰难梭菌感染 - 十年单中心经验。

Faecal microbiota transplantation in the treatment of recurrent intestinal Clostridioides difficile infection - a ten-year single-center experience.

出版信息

Cas Lek Cesk. 2022 Summer;161(3-4):126-130.


DOI:
PMID:36100450
Abstract

Clostridioides difficile (Clostridium difficile in older taxonomy) is a gram-positive anaerobic and bacteria enabled by endospores. Clostridioides difficile is currently the main cause of nosocomial infections in developed countries. Due to the high probability of developing bacterial resistance to treatment and the numerous recurrences in multiple chronic conditions in older adults of our society it causes a widespread medical problem. Faecal microbiota transplantation (FMT) is a highly effective method for treating recurrent intestinal Clostridioides difficile infections (CDI). With this method the potential mechanism of effect is the transmission of a complex intestinal ecosystem, including vital microorganisms, from the donor to the recipient. Presenting the results of monocentric prospective monitoring: Primary aim of the study was to evaluate long-term remission (the continued absence of clinical manifestations of CDI 3 months after FMT administration). The secondary aim of the study was to monitor the short-term remission in the 7 days after FMT administration. Demographic data, information about CDI and the details of therapy were obtained and completed by the treating physician of each patient or by targeted questioning of the patient or their family. We used clinical monitoring to determine the effect of the treatment. The examinations of stool donors and the preparation for a faecal microbiota transplantation were performed according to the currently valid guidelines of the Czech Society of Infectious Diseases for the treatment of the recurrent bacterial infection Clostridioides difficile with faecal microbiota transplantation. The follow-ups took place from February 2011 to July 2021 in the gastroenterology department at the AGEL Ostrava-Vítkovice Hospital and included 116 patients with their first and subsequent recurrence of CDI that were treated with faecal bacteriotherapy. The median age of our patients was 71 years old (the youngest was 19 years old, the oldest 103 years old). 69 women and 47 men took part in the study. 56 patients had their first recurrence of CDI, 41 had a second attack, and 20 patients had a third and subsequent recurrences. In 62 patients (53.4 %), the route of FMT administration was a local enema into the left colon. With 37 patients (31.9 %) we used a colonoscopy after standard anterograde bowel preparation. With 12 patients (10.3 %) gastroscopy administration (deep into the duodenum) was used. 4 patients (3.5 %) were given a nasoenteral tube and one patient (0.9 %) was administered FMT per percutaneous endoscopic gastrostomy (PEG). We applied a frozen universal donor FMT in 81 patients (69.8 %), and a freshly prepared FMT from a person living in the same household was used in 35 patients (30.1 %). The secondary endpoint (the absence of clinical manifestations of CDI within 7 days of FMT administration) was achieved with 102 patients (87.9 %) in our study. The fulfilment of the primary endpoint (the development of long-term remission) was observed with 93 patients (80.2 %). An early administration of FMT appears to be a significant predictor of treatment effect (p = 0.05; OR 5.11; 95% CI 1.65-15.8). Faecal microbiota transplantation is an effective and safe therapy for recurrent intestinal Clostridioides difficile infection, and it respects the up-to-date guidelines for treatment. Of the 116 patients included in our study with first and subsequent CDI, we achieved long-term remission in 80.2 % of them. An early administration of FMT appears to be a significant predictor of treatment effect.

摘要

艰难梭菌(旧分类学中的艰难梭菌)是一种革兰氏阳性厌氧菌,能够形成芽孢。艰难梭菌目前是发达国家院内感染的主要原因。由于治疗中细菌耐药的可能性很高,以及我们社会中老年患者中多种慢性疾病的频繁复发,它导致了广泛的医疗问题。粪便微生物群移植(FMT)是治疗复发性肠道艰难梭菌感染(CDI)的一种非常有效的方法。通过这种方法,潜在的作用机制是从供体向受体传递复杂的肠道生态系统,包括重要的微生物。介绍单中心前瞻性监测结果:研究的主要目的是评估长期缓解(FMT 给药后 3 个月持续无 CDI 临床表现)。研究的次要目的是监测 FMT 给药后 7 天内的短期缓解。收集并由每位患者的治疗医生或通过对患者或其家属的有针对性询问完成人口统计学数据、CDI 信息和治疗细节。我们使用临床监测来确定治疗效果。粪便供体的检查和粪便微生物群移植的准备按照捷克传染病学会目前有效的治疗复发性细菌感染艰难梭菌的粪便微生物群移植指南进行。随访从 2011 年 2 月到 2021 年 7 月在 AGEL 奥斯特拉瓦-维特科维采医院的胃肠病科进行,包括 116 名首次和随后复发 CDI 的患者,他们接受了粪便细菌治疗。我们患者的中位年龄为 71 岁(最年轻的 19 岁,最年长的 103 岁)。69 名女性和 47 名男性参加了这项研究。56 名患者首次复发 CDI,41 名患者第二次发作,20 名患者第三次及以后复发。在 62 名患者(53.4%)中,FMT 的给药途径是将局部灌肠剂注入左侧结肠。37 名患者(31.9%)在标准逆行肠道准备后使用结肠镜检查。12 名患者(10.3%)接受了胃镜检查(深入十二指肠)。4 名患者(3.5%)接受鼻肠管给药,1 名患者(0.9%)接受经皮内镜胃造口术(PEG)FMT。我们在 81 名患者(69.8%)中应用了冷冻通用供体 FMT,在 35 名患者(30.1%)中使用了来自同一家庭的新鲜制备的 FMT。在我们的研究中,102 名患者(87.9%)达到了次要终点(FMT 给药后 7 天内无 CDI 临床表现)。达到主要终点(长期缓解的发展)的患者有 93 名(80.2%)。早期给予 FMT 似乎是治疗效果的显著预测因素(p = 0.05;OR 5.11;95%CI 1.65-15.8)。粪便微生物群移植是治疗复发性肠道艰难梭菌感染的有效且安全的治疗方法,并且它符合最新的治疗指南。在我们纳入的 116 名首次和随后患有 CDI 的患者中,我们有 80.2%的患者达到了长期缓解。早期给予 FMT 似乎是治疗效果的显著预测因素。

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