Fecal Microbiota Transplantation Is Safe and Effective in Patients With Clostridioides difficile Infection and Cirrhosis.
Fecal Microbiota Transplantation Is Safe and Effective in Patients With Clostridioides difficile Infection and Cirrhosis.
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DOI：
10.1016/j.cgh.2020.06.051
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发表时间：
2021-08
期刊：
影响因子：
--
通讯作者：
Fischer M
中科院分区：
文献类型：
--
作者：
Cheng YW;Alhaffar D;Saha S;Khanna S;Bohm M;Phelps E;Ghabril M;Orman E;Sashidhar S;Rogers N;Xu H;Khoruts A;Vaughn B;Kao D;Wong K;Cammarota G;Ianiro G;Dhere T;Kraft CS;Mehta N;Woodworth MH;Allegretti JR;Nativ L;Marcus J;El-Nachef N;Fischer M
艰难梭菌感染（CDI）危害很大一部分肝硬化患者。粪便微生物群移植（FMT）被推荐用于复发性CDI，但其在肝硬化患者中的效果尚未确定。我们进行了一项多中心、观察性研究，以评估FMT治疗肝硬化患者CDI的疗效和安全性。我们进行了一项回顾性研究，涉及63名成人肝硬化患者（终末期肝病评分的中位数模型为14.5; 24名失代偿性肝硬化患者），这些患者于2012年1月至2018年11月在美国、加拿大和意大利的8个学术中心接受了FMT治疗CDI。我们从病历中收集了患者的人口统计学资料和肝硬化、CDI和FMT的特征，并比较了不同严重程度肝硬化患者之间的差异，以及随访8周时FMT成功与失败的差异。我们还获得了FMT 12周内不良事件（AE）和严重AE（SAE）的数据。患者接受FMT治疗复发性CDI（55/63; 87.3%）、重度CDI（6/63; 9.5%）或暴发性CDI（2/63; 3.2%），主要通过结肠镜检查（59/63; 93.7%）作为门诊患者（47/63; 76.8%）。54例患者（85.7%）获得FMT成功。在FMT失败者中，FMT时使用非CDI抗生素的比例较高（44.4% vs 5.6%，p<0.001），Child-Pugh评分为B或C（100% vs 37.7%，p<.001），使用益生菌（77.8% vs 24.1%，p= 0.003），有假膜（22.2% vs 0，p= 0.018），并在住院时接受FMT（45.5% vs 19%，p= 0.039），与FMT成功相比。在多变量分析中，FMT时使用非CDI抗生素（比值比17.43，95% CI：2.00-152.03，p=.01）和使用益生菌（比值比11.9，95% CI：1.81-78.3，p=.01）与FMT失败的风险较高相关。FMT相关AE发生率为33.3%（21/63）-大多数为自限性腹部绞痛或腹泻。只有5起SAE可能与FMT相关;没有涉及感染或死亡。FMT治疗CDI在肝硬化患者中似乎是安全有效的。
Clostridioides difficile infection (CDI) harms a large proportion of patients with cirrhosis. Fecal microbiota transplantation (FMT) is recommended for recurrent CDI, but its effects in patients with cirrhosis have not been established. We performed a multicenter, observational study to evaluate efficacy and safety of FMT for CDI in patients with cirrhosis. We performed a retrospective study involving 63 adults with cirrhosis (median model for end-stage liver disease score 14.5; and 24 patients with decompensated cirrhosis) who underwent FMT for CDI from January 2012 through November 2018 at 8 academic centers in the United States, Canada, and Italy. We collected data on patient demographics and characteristics of cirrhosis, CDI, and FMT from medical records and compared differences among patients with different severities of cirrhosis, and FMT successes vs failures at 8 weeks follow up. We also obtained data on adverse events (AE) and severe AEs (SAE) within 12 weeks of FMT. Patients underwent FMT for recurrent CDI (55/63; 87.3%), severe CDI (6/63; 9.5%), or fulminant CDI (2/63; 3.2%) primarily via colonoscopy (59/63; 93.7%) as outpatients (47/63; 76.8%). FMT success was achieved for 54 patients (85.7%). Among FMT failures, a higher proportion used non-CDI antibiotic use at time of FMT (44.4% vs 5.6%, p<.001), Child-Pugh scores of B or C (100% vs 37.7%, p<.001), used probiotic (77.8% vs 24.1%, p=.003), had pseudomembranes (22.2% vs 0, p=.018), and underwent FMT as inpatients (45.5% vs 19%, p=.039), compared with FMT successes. In multivariable analysis, use of non-CDI antibiotics at time of FMT (odds ratio 17.43, 95% CI: 2.00-152.03, p=.01) and probiotic use (odds ratio 11.9, 95% CI: 1.81-78.3, p=.01) were associated with a greater risk of FMT failure. FMT-related AEs occurred in 33.3% (21/63)—most were self-limited abdominal cramps or diarrhea. There were only five SAEs that were possibly related to FMT; none involved infection or death. FMT for CDI appears to be safe and effective in patients with cirrhosis.
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影响因子：
11.8
作者：
McDonald, L. Clifford;Gerding, Dale N.;Wilcox, Mark H.
通讯作者：
Wilcox, Mark H.
影响因子：
7.6
作者：
Ianiro, G.;Masucci, L.;Cammarota, G.
通讯作者：
Cammarota, G.
影响因子：
4.2
作者：
Dotson, Kierra M.;Aitken, Samuel L.;Garey, Kevin W.
通讯作者：
Garey, Kevin W.
DOI：
10.1016/j.cgh.2018.08.008
发表时间：
2019-01
期刊：
Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association
影响因子：
--
作者：
Acharya C;Bajaj JS
通讯作者：
Bajaj JS
影响因子：
1.8
作者：
Meighani, Alireza;Alimirah, Maryam;Salgia, Reena
通讯作者：
Salgia, Reena