Digestive Disease Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy.
Microbiology Unit, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
J Autoimmun. 2023 Dec;141:103033. doi: 10.1016/j.jaut.2023.103033. Epub 2023 Apr 19.
Clostridioides difficile infection (CDI) is a major challenge for healthcare systems. Inflammatory bowel disease (IBD), including ulcerative colitis (UC) and Crohn's disease, is a risk factor for primary and recurrent CDI (rCDI). Moreover, CDI itself often worsens the clinical picture of IBD, increasing the risk of complications. Fecal microbiota transplantation (FMT) is a highly effective treatment for rCDI, but data from patients with IBD and CDI are limited and often referred to mixed cohorts. We aimed to report outcomes from a cohort of patients with UC treated with FMT for rCDI superinfection.
In a retrospective, single-centre cohort study we evaluated characteristics and outcomes of patients with UC who received FMT for rCDI. The primary outcome was negative C. difficile toxin 8 weeks after FMT. Thirty-five patients were included in the analysis. Sixteen patients were cured after single FMT, while 19 patients received repeat FMT. Overall, FMT cured rCDI in 32 patients (91%), and repeat FMT was significantly associated with sustained cure of CDI compared with single FMT (84% vs 50%, p = 0.018). Twenty-four patients (69%) experienced remission or an amelioration of UC activity. Serious adverse events were not observed.
In our cohort of patients with UC, FMT was highly effective in curing rCDI without severe adverse events and repeat FMT was significantly associated with CDI cure. Most patients also experienced remission or amelioration of UC activity after FMT. Our findings suggest that a sequential FMT protocol may be used routinely in patients with UC and rCDI.
艰难梭菌感染（CDI）是医疗系统面临的主要挑战。炎症性肠病（IBD），包括溃疡性结肠炎（UC）和克罗恩病，是原发性和复发性 CDI（rCDI）的危险因素。此外，CDI 本身常常使 IBD 的临床症状恶化，增加并发症的风险。粪便微生物群移植（FMT）是 rCDI 的一种非常有效的治疗方法，但来自 CDI 和 IBD 患者的数据有限，且常涉及混合队列。我们旨在报告 UC 患者接受 FMT 治疗 rCDI 再感染的结果。
在一项回顾性、单中心队列研究中，我们评估了接受 FMT 治疗 rCDI 的 UC 患者的特征和结局。主要结局是 FMT 后 8 周 C. difficile 毒素阴性。分析纳入了 35 例患者。16 例患者单次 FMT 后治愈，19 例患者接受了重复 FMT。总体而言，FMT 治愈了 32 例（91%）rCDI，重复 FMT 与 FMT 单次治疗相比，显著提高了 CDI 的持续治愈率（84% vs 50%，p=0.018）。24 例（69%）患者的 UC 活动得到缓解或改善。未观察到严重不良事件。
在我们的 UC 患者队列中，FMT 治疗 rCDI 非常有效，且无严重不良事件，重复 FMT 与 CDI 治愈显著相关。大多数患者在 FMT 后也经历了 UC 活动的缓解或改善。我们的研究结果表明，序贯 FMT 方案可常规用于 UC 和 rCDI 患者。
