Inflammatory Bowel Disease Affects the Outcome of Fecal Microbiota Transplantation for Recurrent Clostridium difficile Infection.
Inflammatory Bowel Disease Affects the Outcome of Fecal Microbiota Transplantation for Recurrent Clostridium difficile Infection.
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DOI：
10.1016/j.cgh.2016.02.018
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发表时间：
2016-10
期刊：
影响因子：
--
通讯作者：
Sadowsky MJ
中科院分区：
文献类型：
--
作者：
Khoruts A;Rank KM;Newman KM;Viskocil K;Vaughn BP;Hamilton MJ;Sadowsky MJ
患有复发性艰难梭菌感染（CDI）的显著部分的患者患有炎性肠病（IBD）。粪便微生物群移植（FMT）可以打破CDI复发的循环，并且可以在不评估结肠的情况下进行。我们评估了结肠镜FMT在伴或不伴IBD患者中的疗效，以及在此过程中我们是否可以识别IBD患者。我们收集了2008年至2015年在明尼苏达大学接受FMT治疗复发性CDI的272例连续患者的临床元数据和结肠镜检查结果。患者在首次发作后至少有2次CDI自发复发，并且在1次延长抗生素治疗方案后未清除感染。我们在FMT过程中从患者的右半结肠随机收集粘膜活检以鉴定淋巴细胞性或胶原性结肠炎。在FMT后2个月内或2个月时确定清除CDI的失败或成功。在接受FMT的患者中，15%已确定IBD，2.6%在FMT过程中发现IBD。单次结肠镜FMT清除了74.4%的IBD患者和92.1%的非IBD患者的CDI（P = 0.0018）。患者对FMT的反应相似，无论免疫抑制治疗如何。超过四分之一的IBD患者（25.6%）在FMT后出现具有临床意义的IBD发作。在7.4%内镜检查结肠粘膜正常的患者中记录了淋巴细胞性结肠炎;这些患者中仅3例（20%）在清除CDI后需要额外的结肠炎治疗。基于对272例患者的分析，与无IBD的患者相比，FMT在清除IBD患者复发性CDI方面的效果略差，无论是否使用免疫抑制剂治疗。超过25%的IBD患者在FMT后出现疾病发作。淋巴细胞性结肠炎不影响FMT的结果，但这些患者中有一小部分在术后需要药物治疗。
A significant fraction of patients with recurrent Clostridium difficile infections (CDI) have inflammatory bowel disease (IBD). Fecal microbiota transplantation (FMT) can break the cycle of CDI recurrence and can be performed without evaluation of the colon. We evaluated the efficacy of colonoscopic FMT in patients with and without IBD, and whether we could identify IBD in patients during this procedure. We collected clinical meta-data and colonoscopy results from 272 consecutive patients that underwent FMT for recurrent CDI at the University of Minnesota from 2008 through 2015. Patients had at least 2 spontaneous relapses of CDI following their initial episode and did not clear the infection after 1 extended antibiotic regimen. We collected random mucosal biopsies from patients’ right colons to identify lymphocytic or collagenous colitis during the FMT procedure. Failure or success in clearing CDI was determined within or at 2 months after the FMT. Of patients undergoing FMT, 15% had established IBD and 2.6% were found to have IBD during the FMT procedure. A single colonoscopic FMT cleared CDI from 74.4% of patients with IBD and 92.1% of patients without IBD (P = .0018). Patients had similar responses to FMT regardless of immunosuppressive therapy. More than one-quarter of patients with IBD (25.6%) had a clinically significant flare of IBD after FMT. Lymphocytic colitis was documented in 7.4% of patients with endoscopically normal colon mucosa; only 3 of these patients (20%) required additional treatment for colitis after clearance of CDI. Based on an analysis of 272 patients, FMT is somewhat less effective in clearing recurrent CDI from patients with IBD, compared with patients without IBD, regardless of immunosuppressive therapy. More than 25% of patients with IBD have a disease flare following FMT. Lymphocytic colitis did not affect the outcome of FMT, but a small fraction of these patients required pharmacologic treatment after the procedure.
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