Five years of fecal microbiota transplantation-an update of the Israeli experience

查看全文 作　　者：Sharon A [1]Greenberg;Ilan [3]Youngster;Nathaniel A [1]Cohen;Dan M [4]Livovsky;Jacob [5]Strahilevitz;Eran [6]Israeli;Ehud [7]Melzer;Kalman [4]Paz;Naomi Fliss-[1]Isakov;Nitsan [1,2]Maharshak 机构地区：[1]Department of Gastroenterology and Liver Diseases,Tel Aviv Sourasky Medical Center,affiliated with the Sackler Faculty of Medicine,Tel Aviv University,Tel Aviv 6423906,Israel;[2]Bacteriotherapy Clinic,Tel Aviv Sourasky Medical Center,affiliated with the Sackler Faculty of Medicine,Tel Aviv University,Tel Aviv 6423906,Israel;[3]Assaf Harofe Medical Center,Zerifin 70300,Israel;[4]Digestive Diseases Institute,Shaare Zedek Medical Center,Jerusalem 91031,Israel;[5]Department of Clinical Microbiology and Infectious Diseases,Hadassah-Hebrew University,Jerusalem 91120,Israel;[6]Department of Gastroenterology and Liver Diseases,Hadassah-Hebrew University,Jerusalem 91120,Israel;[7]Gastrointestinal and Liver Diseases Institute,Kaplan Medical Center,Rehovot 76100,Israel 出　　处：《World Journal of Gastroenterology》索引2018年第24卷第47期,共12页 摘　　要：AIM To evaluate and describe the efficacy of fecal microbiota transplantation(FMT) for Clostridium difficile infection(CDI) in a national Israeli cohort.METHODS All patients who received FMT for recurrent(recurrence within 8 wk of the previous treatment) or refractory CDI from 2013 through 2017 in all the five medical centers in Israel currently performing FMT were included. Stool donors were screened according to the Israeli Ministry of Health guidelines. Clinical and laboratory data of patients were collected from patients' medical files, and they included indications for FMT, risk factors for CDI and disease severity. Primary outcome was FMT success(at least 2 mo free of CDI-related diarrhea post-FMT). Secondary outcomes included initial response to FMT(cessation of diarrhea within 7 d) and recurrence at 6 mo.RESULTS There were 111 FMTs for CDI, with a median age of 70 years [interquartile range(IQR): 53-82], and 42%(47) males. Fifty patients(45%) were treated via the lower gastrointestinal(LGI, represented only by colonoscopy) route, 37(33%) via capsules, and 24(22%) via the upper gastrointestinal(UGI) route. The overall success rate was 87.4%(97 patients), with no significant difference between routes of administration(P = 0.338). In the univariant analysis, FMT success correlated with milder disease(P = 0.01), ambulatory setting(P < 0.05) and lower Charlson comorbidity score(P < 0.05). In the multivariant analysis, only severe CDI [odd ratio(OR) = 0.14, P < 0.05] and inpatient FMT(OR = 0.19, P < 0.05) were each independently inversely related to FMT success. There were 35(32%) patients younger than 60 years of age, and 14(40%) of them had a background of inflammatory bowel disease.CONCLUSION FMT is a safe and effective treatment for CDI, with capsules emerging as a successful and well-tolerated route. Severe CDI is less likely to respond to FMT. 关 键 词：CLOSTRIDIUM DIFFICILE infection CAPSULES Israel FECAL MICROBIOTA TRANSPLANTATION