免疫功能低下的儿科患者艰难梭菌感染的粪便微生物移植。
Fecal Microbiota Transplantation for Clostridioides difficile Infection in Immunocompromised Pediatric Patients.
机构信息
From the Department of General Pediatrics, Vanderbilt University Medical Center, Nashville, TN.
the Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Mayo Clinic Children's Center, Rochester, MN.
出版信息
J Pediatr Gastroenterol Nutr. 2023 Apr 1;76(4):440-446. doi: 10.1097/MPG.0000000000003714. Epub 2023 Jan 31.
OBJECTIVES
We sought to evaluate the safety and effectiveness of fecal microbiota transplantation (FMT) for recurrent Clostridioides difficile infection (CDI) in pediatric immunocompromised (IC) patients.
METHODS
This is a multicenter retrospective cohort study of pediatric participants who underwent FMT between March 2013 and April 2020 with 12-week follow-up. Pediatric patients were included if they met the definition of IC and were treated with FMT for an indication of recurrent CDI. We excluded patients over 18 years of age, those with incomplete records, insufficient follow-up, or not meeting study definition of IC. We also excluded those treated for Clostridioides difficile recurrence without meeting the study definition and those with inflammatory bowel disease without another immunocompromising condition.
RESULTS
Of 59 pediatric patients identified at 9 centers, there were 42 who met inclusion and no exclusion criteria. Included patients had a median age of 6.7 years. Etiology of IC included: solid organ transplantation (18, 43%), malignancy (12, 28%), primary immunodeficiency (10, 24%), or other chronic conditions (2, 5%). Success rate was 79% after first FMT and 86% after 1 or more FMT. There were no statistically significant differences in patient characteristics or procedural components when patients with a failed FMT were compared to those with a successful FMT. There were 15 total serious adverse events (SAEs) in 13 out of 42 (31%) patients that occurred during the follow-up period; 4 (9.5%) of which were likely treatment-related. There were no deaths or infections with multidrug resistant organisms during follow-up and all patients with a SAE fully recovered.
CONCLUSIONS
The success rate of FMT for recurrent CDI in this pediatric IC cohort is high and mirrors data for IC adults and immunocompetent children. FMT-related SAEs do occur (9.5%) and highlight the need for careful consideration of risk and benefit.
目的
我们旨在评估粪便微生物群移植（FMT）在儿科免疫功能低下（IC）患者复发性艰难梭菌感染（CDI）中的安全性和有效性。
方法
这是一项多中心回顾性队列研究，纳入了 2013 年 3 月至 2020 年 4 月期间接受 FMT 治疗且随访 12 周的儿科患者。纳入标准为：符合 IC 定义且因复发性 CDI 接受 FMT 治疗。排除标准为：年龄＞18 岁、病历资料不完整、随访时间不足或不符合 IC 研究定义、因不符合研究定义的 CDI 复发而接受治疗以及无其他免疫功能低下的条件但患有炎症性肠病。
结果
在 9 家中心共确定了 59 例儿科患者，其中 42 例符合纳入标准且无排除标准。纳入患者的中位年龄为 6.7 岁。IC 的病因包括：实体器官移植（18 例，43%）、恶性肿瘤（12 例，28%）、原发性免疫缺陷（10 例，24%）或其他慢性疾病（2 例，5%）。首次 FMT 后成功率为 79%，1 次或多次 FMT 后成功率为 86%。在 FMT 失败的患者和 FMT 成功的患者之间，患者特征或程序组成部分无统计学差异。在 42 例患者中，有 13 例（31%）患者共发生 15 例总严重不良事件（SAE），其中 4 例（9.5%）可能与治疗相关。在随访期间无死亡或发生耐多药的感染，所有发生 SAE 的患者均完全康复。
结论
在该儿科 IC 队列中，FMT 治疗复发性 CDI 的成功率较高，与 IC 成人和免疫功能正常儿童的数据相似。FMT 相关的 SAE 确实会发生（9.5%），这突出了需要仔细考虑风险和获益。
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