Rescue fecal microbiota transplantation for antibiotic-associated diarrhea in critically ill patients
Posted on 2019-10-22 - 19:05
Abstract Background Antibiotic-associated diarrhea (AAD) is a risk factor for exacerbating the outcome of critically ill patients. Dysbiosis induced by the exposure to antibiotics reveals the potential therapeutic role of fecal microbiota transplantation (FMT) in these patients. Herein, we aimed to evaluate the safety and potential benefit of rescue FMT for AAD in critically ill patients. Methods A series of critically ill patients with AAD received rescue FMT from Chinese fmtBank, from September 2015 to February 2019. Adverse events (AEs) and rescue FMT success which focused on the improvement of abdominal symptoms and post-ICU survival rate during a minimum of 12 weeks follow-up were assessed. Results Twenty critically ill patients with AAD underwent rescue FMT, and 18 of them were included for analysis. The mean of Acute Physiology and Chronic Health Evaluation (APACHE) II scores at intensive care unit (ICU) admission was 21.7 ± 8.3 (range 11–37). Thirteen patients received FMT through nasojejunal tube, four through gastroscopy, and one through enema. Patients were treated with four (4.2 ± 2.1, range 2–9) types of antibiotics before and during the onset of AAD. 38.9% (7/18) of patients had FMT-related AEs during follow-up, including increased diarrhea frequency, abdominal pain, increased serum amylase, and fever. Eight deaths unrelated to FMT occurred during follow-up. One hundred percent (2/2) of abdominal pain, 86.7% (13/15) of diarrhea, 69.2% (9/13) of abdominal distention, and 50% (1/2) of hematochezia were improved after FMT. 44.4% (8/18) of patients recovered from abdominal symptoms without recurrence and survived for a minimum of 12 weeks after being discharged from ICU. Conclusion In this case series studying the use of FMT in critically ill patients with AAD, good clinical outcomes without infectious complications were observed. These findings could potentially encourage researchers to set up new clinical trials that will provide more insight into the potential benefit and safety of the procedure in the ICU. Trial registration ClinicalTrials.gov, Number NCT03895593 . Registered 29 March 2019 (retrospectively registered).
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Dai, Min; Liu, Yafei; Chen, Wei; Buch, Heena; Shan, Yi; Chang, Liuhui; et al. (2019). Rescue fecal microbiota transplantation for antibiotic-associated diarrhea in critically ill patients. figshare. Collection. https://doi.org/10.6084/m9.figshare.c.4707815.v1
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AUTHORS (22)
MD
Min Dai
YL
Yafei Liu
WC
Wei Chen
HB
Heena Buch
YS
Yi Shan
LC
Liuhui Chang
YB
Yong Bai
CS
Chen Shen
XZ
Xiaoyin Zhang
YH
Yufeng Huo
DH
Dian Huang
ZY
Zhou Yang
ZH
Zhihang Hu
XH
Xuwei He
JP
Junyu Pan
LH
Lili Hu
XP
Xinfang Pan
XW
Xiangtao Wu
BD
Bin Deng
ZL
Zhifeng Li