难治性梭状芽胞杆菌复发的合并症和粪便微生物移植失败-前瞻性前瞻性观察队列研究。,BMC Infectious Diseases

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难治性梭状芽胞杆菌复发的合并症和粪便微生物移植失败-前瞻性前瞻性观察队列研究。
BMC Infectious Diseases ( IF 3.4 ) Pub Date : 2020-01-16 , DOI: 10.1186/s12879-020-4773-x
M Kachlíková ₁ , P Sabaka ₁ , A Koščálová ₂ , M Bendžala ₁ , Z Dovalová ₁ , I Stankovič ₁

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背景技术粪便微生物移植（FMT）是目前最有效的复发性艰难梭菌感染（CDI）的治疗方法。但是，多达20％的患者在单次FMT后会再次复发。导致FMT失败的机制及其风险因素了解甚少。合并症是复发性CDI标准抗生素治疗失败的危险因素之一。不知道合并症是否也与FMT失败的风险有关。方法我们进行了一项前瞻性观察队列研究，以阐明合并症是否与FMT失败有关。招募了经微生物学证实为复发性CDI的患者，并通过保留灌肠进行了FMT。FMT后对患者进行了12周的随访，以了解CDI复发的体征和症状。单一FMT失败的定义为在随访的12周中的任何时间点，腹泻的复发和粪便艰难梭菌抗原或毒素的阳性大便检查。我们评估了单个FMT故障与可能的可管理和不可管理的风险因素的关联。作为合并症的替代指标，我们使用了Charlson合并症指数（CCI）≥7。结果本研究共纳入60例接受单次FMT的患者（34名女性，26名男性）。总体而言，有15位患者（25％）经历了单次FMT失败。CCI≥7的患者为24名（40％），CCI≥7的患者为45.0％的患者单次FMT失败。与单次FMT成功的患者相比，单次FMT失败的患者的CCI显着提高，白蛋白浓度也明显降低。年龄没有差别，C反应蛋白浓度，白细胞计数和从FMT到首次排便的时间。在多变量分析中，CCI≥7与单次FMT的失败呈正相关。对性别，年龄，从FMT到首次排便的时间，伴随的PPI治疗，严重的CDI，医院获得性感染和白蛋白浓度进行了分析。结论CCI替代的共病状态与单一FMT在复发性CDI治疗中的失败呈正相关。

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Comorbid status and the faecal microbial transplantation failure in treatment of recurrent Clostridioides difficile infection - pilot prospective observational cohort study.

BACKGROUND Faecal microbial transplantation (FMT) is currently the most effective treatment of recurrent Clostridioides difficile infection (CDI). However, up to 20% of patients experience further recurrences after single FMT. The mechanisms that lead to FMT failure and its risk factors are poorly understood. Comorbidity is one of the risk factors of the failure of standard antibiotic therapy of recurrent CDI. It is not known if comorbidity is also associated with the risk of FMT failure. METHODS We conducted a prospective observational cohort study in order to elucidate if comorbid status is associated with FMT failure. Patients with microbiologically proven recurrent CDI were recruited and underwent FMT via retention enema. Patients were followed up for 12 weeks after FMT for signs and symptoms of CDI recurrence. Single FMT failure was defined as recurrence of diarrhoea and a positive stool test for the presence of C. difficile antigen or toxin at any time point during the 12 weeks of follow-up. We assessed the association of single FMT failure with possible manageable and unmanageable risk factors. As a surrogate of comorbid status, we used Charlson Comorbidity Index (CCI) ≥ 7. RESULTS A total of 60 patients that underwent single FMT (34 women, 26 men) were included in the study. Overall, 15 patients (25%) experienced single FMT failure. 24 patients (40%) had CCI ≥ 7, and 45.0% patients with CCI ≥ 7 experienced failure of single FMT. Patients who experienced single FMT failure had a significantly higher CCI and significantly lower albumin concentration as compared to patients who experienced single FMT success. There was no difference in age, C-reactive protein concentration, leukocyte count and time from FMT to first defecation. In multivariate analysis, CCI ≥ 7 was positively associated with the failure of single FMT. Analysis was controlled for sex, age, time from FMT to first defecation, concomitant PPI therapy, severe CDI, hospital-acquired infection and albumin concentration. CONCLUSIONS Comorbid status surrogated by CCI is positively associated with the failure of single FMT in the treatment of recurrent CDI.

更新日期：2020-01-17

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