Gut-sparing treatment of urinary tract infection in patients at high risk of Clostridium difficile infection.
Gut-sparing treatment of urinary tract infection in patients at high risk of Clostridium difficile infection.
复制标题
艰难梭菌感染高危患者尿路感染的肠道保护治疗。
DOI：
10.1093/jac/dkw499
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发表时间：
2017
期刊：
影响因子：
--
通讯作者：
Khoruts,Alexander
中科院分区：
文献类型：
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作者：
Staley,Christopher;Vaughn,ByronP;Graiziger,CarolynT;Sadowsky,MichaelJ;Khoruts,Alexander
背景：接受粪便微生物群移植（FMT）治疗复发性艰难梭菌感染（RCDI）的患者再次感染c的风险明显增加。新的抗生素挑衅很困难。尿路感染（uti）是这些患者使用抗生素的常见适应症，通常导致艰难梭菌感染。方法：我们报告了19例经静脉注射氨基糖苷类药物治疗尿路感染的患者。采用3天门诊方案，每天一次肌注庆大霉素治疗18例连续的无并发症UTI的FMT受者。另一名患者因复杂的尿路感染接受静脉注射阿米卡星治疗。研究人员利用16S rRNA基因谱来追踪三名患者在该方案中粪便微生物群落结构的变化。结果：该方案治疗尿路感染症状效果显著。没有患者再次感染c。固执的。肌肉注射庆大霉素后，粪便微生物群落未受影响。结论：尽管近年来不受欢迎，氨基糖苷类抗生素肠外给药的优势是渗透到肠腔最小。短时间（3天）的肠外庆大霉素治疗尿路感染是安全有效的。艰难梭菌感染而不扰乱他们的肠道微生物群。
Background:Recipients of faecal microbiota transplantation (FMT) in treatment of recurrentClostridium difficileinfection (RCDI) remain at markedly increased risk of re-infection withC. difficilewith new antibiotic provocations. Urinary tract infections (UTIs) are common indications for antibiotics in these patients, often resulting inC. difficilere-infection.Methods:We present a case series of 19 patients treated with parenteral aminoglycosides for UTI following FMT for RCDI. A 3 day outpatient regimen of once-daily intramuscular administration of gentamicin was used to treat 18 consecutive FMT recipients with uncomplicated UTI. One other patient was treated for a complicated UTI with intravenous amikacin. Profiling of 16S rRNA genes was used to track changes in faecal microbial community structure during this regimen in three patients.Results:The protocol was highly effective in treating UTI symptoms. None of the patients suffered a re-infection withC. difficile. The faecal microbial communities remained undisturbed by treatment with intramuscular administration of gentamicin.Conclusions:Despite falling out of favour in recent years, aminoglycoside antibiotics given parenterally have the advantage of minimal penetration into the gut lumen. A brief (3 day) course of parenteral gentamicin was safe and effective in curing UTI in patients at high risk ofC. difficileinfection without perturbing their gut microbiota.