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《Journal of microbiology, immunology, and infection》2019,52(6):841-850
Clostridium difficile infection (CDI) remains a major public health issue, and fecal microbiota transplantation (FMT) has become one of the standard therapies for recurrent or refractory CDI. When compared to medical therapies, such as metronidazole or vancomycin, FMT has a high rate of treatment response with acceptable safety and efficiency. Following promulgation of the amendments in September 2018 in Taiwan, FMT has been indicated for recurrent or refractory CDI. The Taiwan Microbiota Consortium contributed to the Taiwan FMT Expert Consensus, which established basic norms and stipulated essential principles, including the indications for transplantation, eligible locations and personnel, donor screening policies, fecal sample handling, and post-FMT follow-up. However, establishing an eligible FMT team in a qualified hospital remains a clinical challenge, and the requirement for facilities and well-screened donors impedes the implementation of FMT. In this review, we aim to provide domestic FMT teams with explicit instructions to facilitate realization and increase the practice of FMT. Based on the Taiwan FMT Expert Consensus and current regulations, we performed a literature review and integrated the experiences of Taiwanese multidisciplinary experts into this article. The content intends to offer clinicians up-to-date evidence and highlight the essential points of FMT. 相似文献
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ABSTRACTIntroduction: Up to 15% of hospitalized patients with Clostridioides difficile infection (CDI) develop severe CDI (SCDI) or Fulminant CDI (FCDI). Due to high rates of mortality in medically-refractory CDI cases, 30% of patients with severe infection historically require surgical intervention. However, colectomy itself is an imperfect solution because it is difficult to predict who will fail medical therapy, patients with SCDI are more likely to have underlying medical conditions that make them poor surgical candidates, and post-surgical mortality still approaches 30–50%.Areas covered: This review will serve as a clinically-based review of severe and fulminant CDI management including discussion of models to predict severe infection, emerging treatments, novel targets for therapy, and innovations in surgical management.Expert opinion: Among the most promising studies to emerge in the last decade have involved fecal microbiota transplantation (FMT), which is already recommended by multiple society guidelines for recurrent CDI (RCDI). In the case of SCDI/FCDI, multiple studies have safely and successfully utilized FMT to produce rates of cure in the 70–90% range. Additionally, patients who have FCDI refractory to medical therapy and are poor candidates for colectomy may benefit from FMT as salvage therapy. 相似文献
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背景 妊娠期糖尿病(GDM)在近年妊娠期疾病中所占比例日益增加,其高发病率为我国母婴健康和公共卫生事业带来了巨大危害。目前研究提示人类肠道菌群的结构改变与相关代谢性疾病密切相关,越来越多的证据提示肠道菌群结构和相对比例的改变可能是糖尿病、肥胖等疾病的高危因素。目的 探究肠道球形梭菌和多形拟杆菌水平改变与GDM发生之间的关系。方法 本研究为巢式病例对照研究。选取2018-03-01至2019-03-30于新疆医科大学第一附属医院就诊的1 034例妊娠妇女,在其首次就诊于本院并确认妊娠时纳入观察队列,之后每4周返回医院行随访并完成产检,当确诊GDM时为最后一次随访。将确诊为GDM的受试者作为病例组,依据病例组受试者年龄、孕周、时间等相关信息进行1∶1匹配对照组受试者。比较对照组和病例组一般资料,入组时、妊娠20周、诊断GDM时球形梭菌、多
形拟杆菌水平。分析病例组不同时间点球形梭菌及多形拟杆菌与空腹血糖间的相关性。结果 1 034例观察队列中,28例受试者中途退出,5例受试者失访,故共计1 001例受试者完成随访,其中90例(8.99%)被诊断为GDM,即病例组。对照组与病例组年龄、受教育程度、糖尿病家族史发生率、腹围、多囊卵巢综合征发生率、高血压发生率比较,差异无统计学意义(P>0.05)。两组入组时球形梭菌、多形拟杆菌水平比较,差异无统计学意义(P>0.05);病例组妊娠20周、诊断GDM时球形梭菌、多形拟杆菌水平高于对照组(P<0.05)。病例组妊娠20周、诊断GDM时球形梭菌、多形拟杆菌水平高于入组时(P<0.05);对照组在病例组诊断GDM对应的时间点的多形拟杆菌水平高于入组时和妊娠20周时(P<0.05)。病例组诊断GDM时球形梭菌、多形拟杆菌与诊断GDM时空腹血糖呈正相关(r值分别为0.435、0.342,P值分别为<0.001、0.001)。结论 球形梭菌与多形拟杆菌的结构改变可能是导致GDM发病的原因之一。 相似文献
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《Journal of infection and chemotherapy》2020,26(5):438-443
ObjectiveTo characterize treatment pattern, incidence and diagnosis of hospital-onset Clostridioides difficile infection (CDI) in Japan, cases were studied over a 9-year period using a large, administrative database.MethodsThis was a retrospective, cross-sectional analysis of inpatients at 320 Japanese Diagnosis-Procedure Combination (DPC) hospitals. Hospitalizations between April 2008 and March 2017 were extracted for patients aged ≥18 years. CDI was defined as CDI treatment plus CDI diagnosis or positive enzyme immunoassay (EIA) result. Endpoints included treatment (type, route, daily dose, duration), time to CDI onset from admission, and time to recurrence (rCDI) from the end of treatment. Chronological changes were reported for treatment pattern, CDI incidence and EIA testing.ResultsThe analysis included 11,823 CDI hospitalizations, 1359 with rCDI. Overall, oral metronidazole (MNZ), oral vancomycin (VCM), and intravenous MNZ were used in 50.2%, 42.1% and 1.2% of CDI hospitalizations, respectively. From 2009 to 2017, CDI hospitalizations treated with MNZ more than doubled and VCM more than halved. Median (Q1–Q3) time to CDI and rCDI onset was 25 (11–52) days and 10 (6–17.5) days, respectively. Median treatment duration ranged from 8 to 10 days and median dose was 1 g/day for both MNZ and VCM. CDI incidence remained steady from 2010 until 2017 (0.99/10,000 patient-days) and EIA testing density doubled from 2008 to 2017 (24.46/10,000 patient-days).ConclusionOral MNZ has become the primary CDI treatment in Japanese DPC hospitals. The treatment duration and dose were aligned to the package insert. CDI diagnostic testing density increased over time, CDI incidence did not.Clinical trial registration numberN/A. 相似文献
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Rita D. Shelby Grace E. Janzow Lauren Mashburn-Warren Jeffrey Galley Natalie Tengberg Jason Navarro 《Gut microbes》2020,12(1)
ABSTRACT Clostridioides difficile infection (CDI) is a common cause of antimicrobial-associated diarrhea. Probiotics have shown variable results in decreasing its incidence and severity. We examined the efficacy of Lactobacillus reuteri administered using a novel probiotic biofilm delivery system in the treatment and prevention of CDI in a murine model.
For prophylactic therapy, mice received an oral antibiotic cocktail followed by clindamycin injection, followed by probiotic administration (planktonic vs. biofilm state), followed by C. difficile oral gavage. For treatment therapy, mice received antibiotics and C. difficile first, followed by probiotic administration. Clinical sickness scores (CSS) and intestinal histologic injury scores (HIS) were assigned. 相似文献
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产气荚膜梭菌是一种分布广泛的条件致病菌,可以导致人与动物多种疾病,其中包括坏死性肠炎、气性坏疽、食物中毒等主要病症。群体感应是细菌之间一种重要的通讯机制,参与调节细菌毒素分泌和致病相关等重要过程。通过对产气荚膜梭菌的群体感应研究现状进行系统介绍,主要描述该菌所含群体感应系统的种类,各个群体感应与生物膜、毒素等致病相关表型的调控机制。产气荚膜梭菌已被证明具有两种群体感应系统,参与该菌毒素产生、生物被膜形成、孢子形成等致病性状。本研究进展为今后进一步研究产气荚膜梭菌致病相关机理提供一定理论基础,同时也为产气荚膜梭菌的生物防控提供新的思路。今后研究应绘制出产气荚膜梭菌完整的QS系统,进一步寻找安全有效的抗感染疗法。 相似文献
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Kelsea M. Drall Catherine J. Field Andrea M. Haqq Russell J. de Souza Hein M. Tun Nadia P. Morales-Lizcano 《Gut microbes》2020,12(1)
ABSTRACT In Canada and the US, the infant diet is supplemented with vitamin D via supplement drops or formula. Pregnant and nursing mothers often take vitamin D supplements. Since little is known about the impact of this supplementation on infant gut microbiota, we undertook a study to determine the association between maternal and infant vitamin D supplementation, infant gut microbiota composition and Clostridioides difficile colonization in 1,157 mother-infant pairs of the CHILD (Canadian Healthy Infant Longitudinal Development) Cohort Study over 2009–2012. Logistic and MaAsLin regression were employed to assess associations between vitamin D supplementation, and C. difficile colonization, or other gut microbiota, respectively. Sixty-five percent of infants received a vitamin D supplement. Among all infants, infant vitamin D supplementation was associated with a lower abundance of genus Megamonas (q = 0.01) in gut microbiota. Among those exclusively breastfed, maternal prenatal supplementation was associated with lower abundance of Bilophila (q = 0.01) and of Lachnospiraceae (q = 0.02) but higher abundance of Haemophilus (q = 0.02). There were no differences in microbiota composition with vitamin D supplementation among partially and not breastfed infants. Neither infant nor maternal vitamin D supplementation were associated with C. difficile colonization, after adjusting for breastfeeding status and other factors. However, maternal consumption of vitamin-D fortified milk reduced the likelihood of C. difficile colonization in infants (adjustedOR: 0.40, 95% CI: 0.19–0.82). The impact of this compositional difference on later childhood health, especially defense against viral respiratory infection, may go beyond the expected effects of vitamin D supplements and remains to be ascertained. 相似文献
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