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新媒体管家
检索丨唐文瑞 湘潭市中心医院
翻译丨唐文瑞 湘潭市中心医院
审核丨潘红平 玉溪市人民医院
陈志锦 东莞市厚街医院
纽约（路透社健康专栏） -来自法国研究人员表示：患者接受早期粪便微生物群移植（FMT）的严重艰难梭菌感染（CDI）患者的生存率有所提高。
马赛医科大学地中海感染医院的Matthieu Million博士告诉路透社：“我们建议在新环境中首次使用一种相对较新的武器(FMT)作为一线治疗方法，并尽可能快地投入使用。根据明确的标准对严重程度进行即时评估是至关重要的，因为在没有严重感染的病人中，此项武器对于生存是没有益处的。”
Million博士的团队先前的研究表明，早期的FMT对由高毒力O27核糖体型引起的CDI患者的生存率有所提高。在本研究中，他们回顾了111位因CDI住院治疗患者的结果(年龄中位数82岁；范围：34-104岁)，包括66名接受早期FMT治疗的患者和45名未接受FMT治疗的患者。
他们在《临床传染病杂志》的8月24日在线报告中指出，在FMT组中诊断出CDI后三个月的死亡率为12.1%，而在仅使用抗生素对照组的死亡率达42.2%。在多变量模型中，随着年龄的增加，合并症的增多，O27核型和严重CDI是较高死亡率的独立预测因子，然而单独的FMT治疗预测更好的生存期。
在亚组分析中，无论O27核糖体型是什么，FMT都能降低死亡率，在接受FMT治疗的患者中，死亡率在冷冻FMT和新鲜FMT之间没有差异。
在考虑了其他变量后，FMT只有在严重结肠炎患者中，才能降低死亡率。Million博士建议在严重感染的情况下采取紧急移植；对于非严重感染，仅用抗生素治疗是“合理的”，尽管复发病例还的采取移植治疗。
Million博士总结道，“在严重艰难梭菌感染的情况下，切勿等待，应立即使用万古霉素，并马上将患者转移到一个有能力进行紧急FMT治疗的医疗中心。”
SOURCE: http://bit.ly/2eukUsz
Clin Infect Dis 2017.
原文：
Early Fecal Transplant Improves Survival After Severe C diff Infection
By Will Boggs MD
NEW YORK (Reuters Health) - Patients with severe Clostridium difficile infection (CDI) who receive early fecal microbiota transplant (FMT) have improved survival, researchers from France report.
Dr. Million's team previously showed that early FMT is associated with improved survival in patients with CDI caused by the hypervirulent O27 ribotype. In their current report, they review outcomes of 111 patients (median age, 82; range, 34-104) hospitalized for CDI, including 66 patients treated with early FMT and 45 patients not treated with FMT.
The mortality rate at three months after diagnosis of CDI was 12.1% in the FMT group versus 42.2% in the antibiotic-only group, they reported online August 24 in Clinical Infectious Diseases.
In multivariable models, increasing age, increasing comorbidities, the O27 ribotype and severe CDI were independent predictors of higher mortality, whereas FMT treatment independently predicted better survival.
In subgroup analyses, FMT decreased mortality regardless of the O27 ribotype, and among patients treated with FMT, mortality did not differ between frozen and fresh FMT.
After accounting for other variables, FMT decreased mortality only in patients with severe colitis.
He advised urgent graft in case of severe infection; for a non-severe infection, antibiotic treatment alone would be "reasonable," though recurrent cases should be treated with a graft.
Dr. Million concluded, "In case of severe infection with C. difficile, do not wait; start vancomycin immediately and urgently transfer the patient to a center empowered to perform an urgent FMT."
SOURCE: http://bit.ly/2eukUsz
Clin Infect Dis 2017.
图文编辑：小小牧童
审稿：马嘉睿 高晓东
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发表于 2017-9-14 20:07:54