粪菌移植在胃肠疾病及非胃肠疾病临床应用研究的证据现状

粪菌移植（FMT）是指将来自健康供者的粪便微生物群通过各种方法移植到患者的胃肠道中,目的是恢复患者正常的微生物群并治疗疾病。FMT最有效和最充分的研究指征是复发性难辨梭菌感染（rCDI）。目前正在探索FMT作为其他胃肠疾病的潜在疗法,如炎症性肠病（IBD）、肠易激综合征（IBS）等;虽然尚无足够证据推荐FMT用于非胃肠疾病,如慢性疲劳综合征、帕金森病、肥胖和代谢综合征,以及多发性硬化症等,但是FMT在非胃肠疾病治疗方面正在迅速兴起。因此,本文主要综述FMT临床应用研究的证据现况。     

Molecular detection of pathogenic bacteria in the colonic biopsies from patients with Ulcerative Colitis

Background/AimUlcerative Colitis (UC) is an inflammatory bowel disease which is common in many areas of the world including Egypt. A lot of controversy regarding the pathogenesis of UC exist. The current study is an attempt to detect some pathogenic bacteria in UC patients.Materials and methodsEndoscopic colonic biopsies obtained from 40 patients with ulcerative colitis and 20 controls were analyzed by means of real-time PCR technique for the presence of Clostridium difficile, Helicobacter Pylori (H. pylori) and pathogenic Escherichia Coli (E. coli) which are positive for KPC and/or OXA-48.ResultsAll patients and control samples were negative for Clostridium difficile. Three of the 40 patient samples (7.5%) and none of the 20 controls were positive for H. pylori with no significant difference between the two groups. KPC-positive E. coli were detected in 11 of the 40 patients (27.5%) and in none of the controls with a significant difference between the two groups (P=0.01). All patients and control samples were negative for OXA-48 positive E. coli.ConclusionAlthough this study does not support the claim that Clostridium difficile and/or H. pylori have a role in UC, it greatly suggests that pathogenic E. coli may be involved in one way or another in the course of UC.     

Our experience with 80 cases of SARS-CoV-2-Clostridioides difficile co-infection: An observational study

Beside the changes in the gut microbiota in context of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, the increased use of high-risk broad-spectrum antibiotics during the actual pandemic raises concerns about a possible increase of Clostridioides difficile infections (CDIs).We retrospectively analyzed 80 consecutive patients, with SARS-CoV-2 pneumonia and CDI.The mean length of hospitalization was 19.63 days. The mean time of the onset of the digestive symptoms related to CDI was 5.16 days. Patients with an onset of the digestive symptoms from hospital admission have a significantly lower median length in hospital stay. The recovered patients present a statistically significant decreased median age. coronavirus disease 2019 (COVID-19) cured patients present CDI symptoms much earlier than the deceased patients, when comparing the median days before the occurrence of any digestive symptoms regarding CDI. Among the patients that prior to their hospitalization for COVID-19 were exposed to antibiotics, 54.7% presented CDI digestive symptoms during their hospitalization and 65.6% had a severe or critical COVID-19 form.Although the incidence of CDI in the pandemic is lower compared to the period before the pandemic, the severity of cases and the death rate increased. In the actual setting clinicians need to be aware of possible CDI and SARS-CoV-2 co-infection.     

Fecal microbiota transplantation as potential first-line treatment for patients with Clostridioides difficile infection and prior appendectomy

Clostridioides difficile infection (CDI) is a global health problem. The association of appendectomy on the severity and prognosis of CDI has been reported in many literatures, but there are still contradictions. In a retrospective study entitled “Patients with Closterium diffuse infection and prior appendectomy may be prone to word outcomes” published in World J Gastrointest Surg 2021, the author found that prior appendectomy affects the severity of CDI. Appendectomy may be a risk factor for increasing the severity of CDI. Therefore, it is necessary to seek alternative treatment for patients with prior appendectomy when they are more likely to have severe or fulminant CDI.     

Overview of current detection methods and microRNA potential in Clostridioides difficile infection screening

Clostridioides difficile (formerly called Clostridium difficile,C.difficile) infection (CDI)is listed as an urgent threat on the 2019 antibiotic resistance threats report in the United States by the Centers for Disease Control and Prevention.Early detection and appropriate disease management appear to be essential.Meanwhile,although the majority of cases are hospital-acquired CDI,community-acquired CDI cases are also on the rise,and this vulnerability is not limited to immunocompromised patients...     

Prescribed probiotic usage to prevent Clostridioides difficile infection among older patients receiving antibiotics: A retrospective cohort study

ObjectivesClostridioides difficile infection (CDI) is a leading cause of antimicrobial-associated colitis and is a global clinical concern. Probiotics are considered a CDI-preventive measure; however, highly inconsistent data have been previously reported. Thus, we evaluated the CDI-preventive effect of prescribed probiotics in high-risk older patients receiving antibiotics.MethodsOlder patients (aged ≥65 years) admitted to the emergency department who received antibiotics between 2014 and 2017 were enrolled in this single-center retrospective cohort study. Propensity score-matched analysis was used to compare the CDI incidence in patients who took the prescribed probiotics within 2 days of receiving antibiotics for at least 7 days with those who did not. The rates of severe CDI and associated hospital mortality were also evaluated.ResultsAmong 6148 eligible patients, 221 were included in the prescribed probiotic group. A propensity score-matched (221 matched pairs) well-balanced for patient characteristics was obtained. The incidence of primary nosocomial CDI did not differ significantly between the prescribed and non-prescribed probiotic groups (0% [0/221] vs. 1.0% [2/221], p = 0.156). Of the 6148 eligible patients, 0.5% (30/6148) developed CDI, with a severe CDI rate of 33.3% (10/30). Furthermore, no CDI-associated in-hospital mortality was observed in the study cohort.ConclusionsThe evidence from this study does not support recommendations for the routine use of prescribed probiotics to prevent primary CDI in older patients receiving antibiotics in situations where the CDI is infrequent.     

GeneXpert实时荧光定量PCR在诊断艰难梭菌感染中的临床应用

目的评价Gene Xpert实时荧光定量PCR法在诊断艰难梭菌感染中的应用价值。方法收集住院腹泻患者非重复粪便标本296份,同时进行Gene Xpert试验和产毒素培养(toxigenic culture,TC)。TC包括厌氧培养、菌株基质辅助激光解吸电离飞行时间质谱(MALDI-TOF MS)鉴定、PCR扩增艰难梭菌毒素基因。以TC结果为参考,评价Gene Xpert试验的敏感性、特异性、阳性预测值、阴性预测值,并评价Gene Xpert试验和TC 2种方法结果的一致性。结果 Gene Xpert试验的敏感性、特异性、阳性预测值和阴性预测值分别为98.5%、92.6%、91.7%和98.7%。Gene Xpert试验与TC一致性好(Kappa=0.905)。Gene Xpert试验报告2株RT027型高毒力菌株,经核糖体分型确证为RT027型艰难梭菌。结论 Gene Xpert实时荧光定量PCR可快速、准确检测粪便标本中的艰难梭菌毒素基因,且可报告高毒力RT027型菌株,具有重要的临床应用价值。