NEJM:粪菌移植需要防范耐药性细菌带来的风险
  • 两人在粪菌移植后感染了具有超广谱β-内酰胺类药物抗性的大肠杆菌,导致严重的菌血症;
  • 一名患者是69岁的男性,患有肝硬化,参与一项通过粪菌移植治疗疑难肝性脑病的临床研究,其菌血症被治愈,后出院;
  • 另一名是73岁的男性,患有骨髓增生异常综合征,在实施异体干细胞移植前服用了两次粪菌胶囊,后因重度菌血症死亡;
  • 两人和粪菌供体中含有的大肠杆菌经鉴定为血清型O25:H4,两两之间无或者仅有1个SNP位点差异,故应为同一来源。
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2019年6月13日,由于发生两起由粪菌移植引起的耐药性细菌菌血症病例,FDA发出安全警示(查看文章)并开始强制性的审查相关临床实验,引起大家对粪菌移植这一新生治疗手段的巨大争论。三个多月过去了,NEJM杂志今天刊发了3篇论文,其中一篇来自于这两个患者的医生团队,披露了事件的一些细节。此外,他们还进一步讨论粪菌移植的安全措施,并特别指出了供体筛选的重要性。同期刊发的另两篇评论文章的解读见此(查看文章)(查看文章
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Drug-Resistant E. coli Bacteremia Transmitted by Fecal Microbiota Transplant

肠道菌群移植导致的耐药性大肠杆菌菌血症

10.1056/NEJMoa1910437

2019-10-30, Article

Abstract & Authors:展开

Abstract:收起
Fecal microbiota transplantation (FMT) is an emerging therapy for recurrent or refractory Clostridioides difficile infection and is being actively investigated for other conditions. We describe two patients in whom extended-spectrum beta-lactamase (ESBL)–producing Escherichia coli bacteremia occurred after they had undergone FMT in two independent clinical trials; both cases were linked to the same stool donor by means of genomic sequencing. One of the patients died. Enhanced donor screening to limit the transmission of microorganisms that could lead to adverse infectious events and continued vigilance to define the benefits and risks of FMT across different patient populations are warranted.

First Authors:
Zachariah DeFilipp

Correspondence Authors:
Elizabeth L Hohmann

All Authors:
Zachariah DeFilipp,Patricia P Bloom,Mariam Torres Soto,Michael K Mansour,Mohamad R A Sater,Miriam H Huntley,Sarah Turbett,Raymond T Chung,Yi-Bin Chen,Elizabeth L Hohmann

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New England Journal of Medicine期刊

Fecal Microbiota Transplantation for Dysbiosis — Predictable Risks

2019-10-30

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New England Journal of Medicine期刊

Donor Screening for Fecal Microbiota Transplantation

2019-10-30

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NEJM Journal Watch新闻网站

Fecal Microbiota Transplant — Identification of a New Risk

2019-11-07

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WebMD新闻网站

Tainted Fecal Transplant Killed One Patient

2019-10-30

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