Fecal microbiota transplantation outcomes in immunocompetent and immunocompromised patients: A single-center experience
Fecal microbiota transplantation outcomes in immunocompetent and immunocompromised patients: A single-center experience
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DOI：
10.1111/tid.12726
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发表时间：
2017-08-01
影响因子：
2.6
通讯作者：
Montero, Jose
中科院分区：
文献类型：
--
作者：
Alrabaa, Sally;Jariwala, Ripal;Montero, Jose
背景资料：艰难梭菌感染（CDI）是一个主要的传染病焦点，粪便微生物群移植（FMT）已被用于成功地在各种patient population.Methods：我们进行了一项回顾性研究FMT免疫功能正常和免疫功能低下的患者在我们的中心审查结果，重点是确定风险因素FMT失败的实体器官移植（SOT）患者。FMT进行了使用通用的银行冷冻粪便通过鼻十二指肠管在患者复发CDI的3个或3个以上的事件，我们的机构protocol.Results：13例患者被纳入分析，6谁是免疫功能正常和7谁是免疫功能低下。其中，6例患者有SOT病史，主要是腹部器官接受者。所有免疫功能正常的患者均成功进行了FMT，而3例免疫功能低下的SOT患者失败。两名FMT失败的患者进行了第二次FMT，其中一名患者成功，另一名患者失败。FMT给药未观察到不良事件。FMT失败的预测因子是抗菌素暴露pre-FMT.Conclusions：本研究强调了免疫功能低下患者复发性CDI与可变疗效FMT的安全使用。FMT前的抗菌剂暴露是FMT失败的确定风险因素。可以考虑在SOT患者中使用序贯FMT，但最终需要进一步研究。
Background: Clostridium difficile infection (CDI) is a major infectious disease focus for which fecal microbiota transplantation (FMT) has been used with success in various patient populations.Methods: We conducted a retrospective study of FMT in immunocompetent and immunocompromised patients to review outcomes at our center, with a focus on identifying risk factors for FMT failure in solid organ transplant (SOT) patients. FMT was conducted using universal banked frozen stool via naso-duodenal tube in patients with recurrent CDI of 3 or more episodes per our institutional protocol.Results: Thirteen patients were included in the analysis, 6 who were immunocompetent and 7 who were immunocompromised. Of these, 6 patients had a history of SOT and were primarily abdominal organ recipients. All immunocompetent patients experienced success with FMT, while 3 immunocompromised SOT patients experienced failure. Two patients who failed FMT had a second FMT, which was successful in one patient and failed in the second patient. No adverse events were noted with FMT administration. A predictor of FMT failure was antimicrobial exposure pre-FMT.Conclusions: This study highlights the safe use of FMT for recurrent CDI with variable efficacy in immunocompromised patients. Antimicrobial exposure prior to FMT was an identified risk factor for FMT failure. The use of sequential FMT in SOT patients may be considered but ultimately requires further investigation.