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首页 » 细胞生物学 » AJG:揭示粪便移植或可有效治疗免疫受损病人的梭状芽胞杆菌感染

AJG:揭示粪便移植或可有效治疗免疫受损病人的梭状芽胞杆菌感染

来源:生物谷 2014-07-11 14:15

2014年7月11日 讯 /生物谷BIOON/ --近日,刊登在国际杂志The American Journal of Gastroenterology上的一篇研究论文中,来自国际妇女胃肠道医学研究中心的研究人员通过研究发现,粪便移植对于治疗免疫受损病人艰难梭状芽胞杆菌(C difficile)的感染有效且安全。在过去10年里艰难梭状芽胞杆菌引起了较大的感染流行率,该菌引发的感染往往很难治疗,而且其使患者常常发生腹泻、腹痛及恶心等症状。

研究者Kelly表示,目前并没有研究来调查粪便移植对于免疫受损病人的安全性和有效性,此前这些病人并没有进行粪便移植的相关临床试验,因为这些患者担心其已经处于较高的感染风险之中,而医生们却会谨慎使用粪便移植方法来治疗那些免疫系统受损上的患者。

增加住院时间、延长护理时间以及广谱的抗生素都会增加艰难梭状芽胞杆菌感染免疫受损患者的风险,文章中,研究者Kelly与其同事利用粪便移植治疗了许多免疫受损患者,而且研究人员正在寻找如何来描述免疫受损个体经过治疗的感染治愈率;通过综合分析研究者表示,粪便移植的总体治愈率可以达到89%,在粪便治疗的个体中有12位病人在治疗12周内发生了严重的副作用,其中有2位病人死亡,一人死于结肠镜检查过程中,另一位的死亡和粪便移植疗法并无关联。

“我们的研究阐明了粪便移植对于治疗免疫受损病人艰难梭状芽胞杆菌感染中的疗效,更为重要的是,在高风险病人群体中粪便移植并没有带来相关的感染并发症,”研究者Kelly说道,他还补充道,“本文的关键信息就在于医生们并不需要害怕利用粪便移植来治疗免疫受损的病人,我们的研究揭示了,粪便移植对于治疗免疫受损病人是非常安全且有效的。”(生物谷Bioon.com)

Fecal Microbiota Transplant for Treatment of Clostridium difficile Infection in Immunocompromised Patients

Colleen R Kelly, Chioma Ihunnah, Monika Fischer, Alexander Khoruts, Christina Surawicz, Anita Afzali, Olga Aroniadis, Amy Barto, Thomas Borody, Andrea Giovanelli, Shelley Gordon, Michael Gluck, Elizabeth L Hohmann, Dina Kao, John Y Kao, Daniel P McQuillen, Mark Mellow, Kevin M Rank, Krishna Rao, Arnab Ray, Margot A Schwartz, Namita Singh, Neil Stollman, David L Suskind, Stephen M Vindigni, Ilan Youngster and Lawrence Brandt

OBJECTIVES: Patients who are immunocompromised (IC) are at increased risk of Clostridium difficile infection (CDI), which has increased to epidemic proportions over the past decade. Fecal microbiota transplantation (FMT) appears effective for the treatment of CDI, although there is concern that IC patients may be at increased risk of having adverse events (AEs) related to FMT. This study describes the multicenter experience of FMT in IC patients. METHODS: A multicenter retrospective series was performed on the use of FMT in IC patients with CDI that was recurrent, refractory, or severe. We aimed to describe rates of CDI cure after FMT as well as AEs experienced by IC patients after FMT. A 32-item questionnaire soliciting demographic and pre- and post-FMT data was completed for 99 patients at 16 centers, of whom 80 were eligible for inclusion. Outcomes included (i) rates of CDI cure after FMT, (ii) serious adverse events (SAEs) such as death or hospitalization within 12 weeks of FMT, (iii) infection within 12 weeks of FMT, and (iv) AEs (related and unrelated) to FMT. RESULTS: Cases included adult (75) and pediatric (5) patients treated with FMT for recurrent (55%), refractory (11%), and severe and/or overlap of recurrent/refractory and severe CDI (34%). In all, 79% were outpatients at the time of FMT. The mean follow-up period between FMT and data collection was 11 months (range 3–46 months). Reasons for IC included: HIV/AIDS (3), solid organ transplant (19), oncologic condition (7), immunosuppressive therapy for inflammatory bowel disease (IBD; 36), and other medical conditions/medications (15). The CDI cure rate after a single FMT was 78%, with 62 patients suffering no recurrence at least 12 weeks post FMT. Twelve patients underwent repeat FMT, of whom eight had no further CDI. Thus, the overall cure rate was 89%. Twelve (15%) had any SAE within 12 weeks post FMT, of which 10 were hospitalizations. Two deaths occurred within 12 weeks of FMT, one of which was the result of aspiration during sedation for FMT administered via colonoscopy; the other was unrelated to FMT. None suffered infections definitely related to FMT, but two patients developed unrelated infections and five had self-limited diarrheal illness in which no causal organism was identified. One patient had a superficial mucosal tear caused by the colonoscopy performed for the FMT, and three patients reported mild, self-limited abdominal discomfort post FMT. Five (14% of IBD patients) experienced disease flare post FMT. Three ulcerative colitis (UC) patients underwent colectomy related to course of UC >100 days after FMT. CONCLUSIONS: This series demonstrates the effective use of FMT for CDI in IC patients with few SAEs or related AEs. Importantly, there were no related infectious complications in these high-risk patients.

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