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

World Journal of Gastroenterology 2018年第47期24卷 5403-5414页

作者： Sharon A Greenberg Ilan Youngster Nathaniel A Cohen Dan M Livovsky jacob strahilevitz Eran Israeli Ehud Melzer Kalman Paz Naomi Fliss-Isakov Nitsan Maharshak Department of Gastroenterology and Liver Diseases Tel Aviv Sourasky Medical Centeraffiliated with the Sackler Faculty of MedicineTel Aviv UniversityTel Aviv 6423906Israel Bacteriotherapy Clinic Tel Aviv Sourasky Medical Centeraffiliated with the Sackler Faculty of MedicineTel Aviv UniversityTel Aviv 6423906Israel Assaf Harofe Medical Center Zerifin 70300Israel Digestive Diseases Institute Shaare Zedek Medical CenterJerusalem 91031Israel Department of Clinical Microbiology and Infectious Diseases Hadassah-Hebrew UniversityJerusalem 91120Israel Department of Gastroenterology and Liver Diseases Hadassah-Hebrew UniversityJerusalem 91120Israel Gastrointestinal and Liver Diseases Institute Kaplan Medical CenterRehovot 76100Israel

AIM To evaluate and describe the efficacy of fecal microbiota transplantation(FMT) for Clostridium difficile infection(CDI) in a national Israeli *** 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 *** 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 *** 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

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