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Gastroenterology:粪便微生物菌群移植治疗复发性难治性梭状芽孢杆菌感染的疗效优于菲达霉素

2020-05-31 MedSci原创 MedSci原创

粪便微生物群移植(FMT)被推荐用于治疗复发性艰难梭菌感染(rCDI)。我们进行了一项单中心随机试验,以比较FMT与非达霉素和万古霉素的疗效。

粪便微生物群移植(FMT)被推荐用于治疗复发性艰难梭菌感染(rCDI)。我们进行了一项单中心随机试验,以比较FMT与非达霉素和万古霉素的疗效。

 

我们研究了2016年4月5日至2018年6月10日在丹麦一家胃肠科诊所就诊的rCDI连续成人患者。患者被随机分配到接受FMT的一组,通过结肠镜或鼻空肠管应用,4-10天后接受万古霉素(125 mg 4次/日;FMTv;n = 24),10天后接受非达克霉素(200 mg 2次/日;n = 24),或10天后接受万古霉素(125 mg 4次/日;n = 16)。在此疗程后出现rCDI的患者和无法随机分配到组别的患者,均给予抢救性FMTv。主要结局是在分配的治疗8周后的临床分辨率和艰难梭状芽孢杆菌(CD)毒素的聚合酶链式反应检测结果为阴性。次要终点包括第8周时的临床分辨率。

 

结果显示,所有64名患者均接受了分配的治疗。在给予FMTv治疗的17例患者(71%)、8例患者(33%)和3例患者(19%;FMTv vs 非达索霉素P = .009;FMTv vs万古霉素P = .001;非达索霉素 vs 万古霉素P = .31)中观察到临床缓解和CD检测结果阴性的结果。在22名给予FMTv的患者中观察到了临床分辨率(92%),10名给予飞达霉素的患者(42%)和3名给予万古霉素的患者(19%; P = .0002; P < .0001; P = .13)。结果在接受FMTv作为初始治疗的患者和接受抢救性FMTv的患者之间没有显著差异。有1例严重不良事件可能与FMTv有关。

 

总之,在一项针对rCDI患者的随机试验中,我们发现FMTv组合在临床和微生物学解决或单纯临床解决的终点上优于非达索霉素或万古霉素。

 

原始出处:

 

Christian Lodberg Hvas, Simon Mark Dahl Jørgensen, et al., Fecal Microbiota Transplantation Is Superior to Fidaxomicin for Treatment of Recurrent Clostridium Difficile Infection. Gastroenterology. 2019 Apr;156(5):1324-1332.e3. doi: 10.1053/j.gastro.2018.12.019.

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  5. 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  6. 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  7. 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05:44:34 CST 2020, time=2020-06-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1528662, encodeId=817c152866234, content=<a href='/topic/show?id=74b798601a1' target=_blank style='color:#2F92EE;'>#难治性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=98601, encryptionId=74b798601a1, topicName=难治性)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a1ef11916292, createdName=freve, createdTime=Tue Jun 02 05:44:34 CST 2020, time=2020-06-02, status=1, ipAttribution=)]
    2020-09-24 许安
  8. 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05:44:34 CST 2020, time=2020-06-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1528662, encodeId=817c152866234, content=<a href='/topic/show?id=74b798601a1' target=_blank style='color:#2F92EE;'>#难治性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=98601, encryptionId=74b798601a1, topicName=难治性)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a1ef11916292, createdName=freve, createdTime=Tue Jun 02 05:44:34 CST 2020, time=2020-06-02, status=1, ipAttribution=)]
    2020-06-02 Homburg
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    2020-06-02 freve

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万古霉素是一种常见的抗生素,具有有效的抗革兰氏阳性微生物活性,但是长时间和高剂量的使用能够导致耳毒性。虽然与万古霉素相关的肾毒性具有广泛的报道,耳毒性的案例却很少见到。最近,有研究人员确定了接受长期静脉内注射(IV)万古霉素患者听觉敏度图的不良变化发生情况,并鉴定了那些需要进行听力监测的高风险患者。研究对424名患者进行了筛选;92名患者在使用万古霉素期间至少进行了2次听力测定。53%的患者为男性

抗击艰难梭菌:“粘性抗生素”或可有效减少万古霉素的丢失

伪膜性结肠炎(PE)是由于感染艰难梭菌(有时还会感染金黄色葡萄球菌)而引起的结肠衰弱性炎症。口服万古霉素可以有效杀灭艰难梭菌。为了有效发挥作用,万古霉素必须留在胃肠道中,并且不能被稀释或通过肠壁进入血液而丢失。

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