张发明团队:挽救性粪菌移植治疗ICU抗生素相关性腹泻
  • 中华粪菌库(fmtBank)向全国提供针对难治性肠道感染的挽救性粪菌移植(FMT)治疗;
  • fmtBank救治的18名重症监护室(ICU)抗生素相关性腹泻(AAD)患者,共接受33次挽救性FMT;
  • 72.2%的患者治疗后一周内腹部症状改善,44.4%的患者在随访至少12周内AAD好转无复发且能够离开ICU生存;
  • 38.9%的患者发生FMT相关的不良事件,无FMT相关的感染、死亡等严重不良事件,8例患者死亡均与FMT无关。
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研究报道南京医科大学第二附属医院张发明教授团队通过中华粪菌库(fmtBank)对全国16家ICU重症抗生素相关性腹泻患者进行紧急粪菌救援,研究结果初步显示FMT对这类患者的安全性和挽救治疗价值,并介绍了中华粪菌库的远程FMT救援治疗模式,或可启发与鼓励ICU医生和研究者去思考与勇于尝试新的挽救治疗。
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Critical Care [IF:9.097]

Rescue fecal microbiota transplantation for antibiotic-associated diarrhea in critically ill patients

挽救性粪菌移植治疗危重症患者抗生素相关性腹泻

10.1186/s13054-019-2604-5

2019-10-21, Article

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BACKGROUND: Antibiotic-associated diarrhea (AAD) is a risk factor for exacerbating the outcome of critically ill patients. Dysbiosis induced by the exposure to antibiotics reveals the potential therapeutic role of fecal microbiota transplantation (FMT) in these patients. Herein, we aimed to evaluate the safety and potential benefit of rescue FMT for AAD in critically ill patients.
METHODS: A series of critically ill patients with AAD received rescue FMT from Chinese fmtBank, from September 2015 to February 2019. Adverse events (AEs) and rescue FMT success which focused on the improvement of abdominal symptoms and post-ICU survival rate during a minimum of 12 weeks follow-up were assessed.
RESULTS: Twenty critically ill patients with AAD underwent rescue FMT, and 18 of them were included for analysis. The mean of Acute Physiology and Chronic Health Evaluation (APACHE) II scores at intensive care unit (ICU) admission was 21.7 ± 8.3 (range 11-37). Thirteen patients received FMT through nasojejunal tube, four through gastroscopy, and one through enema. Patients were treated with four (4.2 ± 2.1, range 2-9) types of antibiotics before and during the onset of AAD. 38.9% (7/18) of patients had FMT-related AEs during follow-up, including increased diarrhea frequency, abdominal pain, increased serum amylase, and fever. Eight deaths unrelated to FMT occurred during follow-up. One hundred percent (2/2) of abdominal pain, 86.7% (13/15) of diarrhea, 69.2% (9/13) of abdominal distention, and 50% (1/2) of hematochezia were improved after FMT. 44.4% (8/18) of patients recovered from abdominal symptoms without recurrence and survived for a minimum of 12 weeks after being discharged from ICU.
CONCLUSION: In this case series studying the use of FMT in critically ill patients with AAD, good clinical outcomes without infectious complications were observed. These findings could potentially encourage researchers to set up new clinical trials that will provide more insight into the potential benefit and safety of the procedure in the ICU.
TRIAL REGISTRATION: ClinicalTrials.gov, Number NCT03895593 . Registered 29 March 2019 (retrospectively registered).

First Authors:
Min Dai

Correspondence Authors:
Bota Cui,Faming Zhang

All Authors:
Min Dai,Yafei Liu,Wei Chen,Heena Buch,Yi Shan,Liuhui Chang,Yong Bai,Chen Shen,Xiaoyin Zhang,Yufeng Huo,Dian Huang,Zhou Yang,Zhihang Hu,Xuwei He,Junyu Pan,Lili Hu,Xinfang Pan,Xiangtao Wu,Bin Deng,Zhifeng Li,Bota Cui,Faming Zhang

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