Effect of antibiotic pretreatment on bacterial engraftment after Fecal Microbiota Transplant (FMT) in IBS-D.
Effect of antibiotic pretreatment on bacterial engraftment after Fecal Microbiota Transplant (FMT) in IBS-D.
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DOI：
10.1080/19490976.2021.2020067
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发表时间：
2022-01
期刊：
影响因子：
12.2
通讯作者：
Lembo A
中科院分区：
文献类型：
--
作者：
Singh P;Alm EJ;Kelley JM;Cheng V;Smith M;Kassam Z;Nee J;Iturrino J;Lembo A
粪便微生物群移植（FMT）是纠正肠道易激综合征（IBS-D）微生物生态失调的一种有吸引力的策略。虽然FMT的机制被认为是细菌植入，但在IBS-D（和其他疾病）中FMT后实现植入的最佳方法尚不清楚。我们评估了FMT（有或没有抗生素预处理）对IBS-D患者肠道微生物组和症状的影响。在这项随机、安慰剂对照、单中心研究中，44例严重程度为最轻中度的IBS-D患者（IBS严重程度评分系统，即，IBS-SSS ≥175）随机分为4组：单剂量口服FMT、环丙沙星和甲硝唑（CM-FMT）或利福昔明（R-FMT）7天预处理后单剂量口服FMT或安慰剂FMT。主要终点是FMT后的植入，次要终点是第10周时IBS-SSS和IBS-生活质量（IBS-QOL）的变化。三个FMT组的中位植活率有显著差异（P = 0.013）。与R-FMT组（5%，P = 0.04）和CM-FMT组（2.4%，P = 0.002）相比，单独FMT组（15.5%）的FMT后植入率显著更高。第10周时，4个组之间或3个FMT联合组与安慰剂组之间IBS-SSS和IBS-QOL较基线的平均变化无显著差异。总之，抗生素预处理显著减少IBS-D患者FMT后的细菌植入。
Fecal microbiota transplantation (FMT) is an attractive strategy to correct microbial dysbiosis in diarrhea-predominant irritable bowel syndrome (IBS-D). Although the mechanism of FMT is thought to be bacterial engraftment, the best approach to achieve engraftment after FMT in IBS-D (and other diseases) is not clear. We evaluated the effect of FMT (with or without pretreatment with antibiotics) on gut microbiome and symptoms in patients with IBS-D. In this randomized, placebo-controlled, single-center study, 44 patients with IBS-D with a least moderate severity (IBS severity scoring system, i.e., IBS-SSS, ≥175) were randomly assigned to one of four groups: single-dose oral FMT alone, single-dose oral FMT following a 7-day pretreatment course of Ciprofloxacin and Metronidazole (CM-FMT) or Rifaximin (R-FMT), or Placebo FMT. Primary endpoint was engraftment post-FMT and secondary endpoints were changes in IBS-SSS, and IBS-quality of life (IBS-QOL) at week 10. Median engraftment was significantly different among the three FMT groups (P = .013). Engraftment post-FMT was significantly higher in the FMT alone arm (15.5%) compared to that in R-FMT group (5%, P = .04) and CM-FMT group (2.4%, P = .002). The mean change in IBS-SSS and IBS-QOL from baseline were not significantly different among the four groups or between the three FMT groups combined vs. placebo at week 10. In summary, antibiotic pretreatment significantly reduced bacterial engraftment after FMT in patients with IBS-D.
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