Fecal Microbiota Transplantation (FMT) for Treatment of Clostridium difficile Infection (CDI) in Immunocompromised Patients: ACG Governors Award for Excellence in Clinical Research
Notice bibliographique
Résumé
Purpose: Patients who are immunocompromised (IC) are at increased risk of CDI, which has increased to epidemic proportions over the past decade. FMT appears effective for the treatment of CDI, though there is concern that IC patients may be at increased risk of having adverse events (AE) related to FMT. In this multicenter study, we aimed to describe rates of CDI cure after FMT as well as AE experienced by IC patients after FMT. Methods: A multicenter retrospective series was performed of the use of FMT in IC patients with CDI that was recurrent, refractory, or severe. A 32-item questionnaire soliciting demographic and pre- and post-FMT data was completed at 16 centers for 83 patients, of which 66 were eligible based on at least 12 weeks of post-FMT follow up. Outcomes included: (1) rates of CDI cure after FMT, (2) serious adverse events (SAE) such as death or hospitalization within 12 weeks of FMT, (3) infection within 12 weeks of FMT, and (4) AE related and unrelated to FMT. Results: Cases included adult (61) and pediatric (5) patients treated with FMT for refractory (12%), recurrent (54%), and overlap of recurrent/refractory and severe CDI (34%). Seventy eight percent were outpatients at time of FMT. The mean follow-up period between FMT and data collection was 12 months (range: 3-51 months). Reasons for IC included: HIV/AIDS (2), solid organ transplant (14), oncologic conditions (6), immunosuppressive therapy for IBD (32), and other IC due to medical condition/medication (12). The CDI cure rate after a single FMT was 78%, with 52 patients experiencing no recurrence at least 12 weeks post-FMT. Nine patients underwent repeat FMT, of which seven had no further CDI. Thus, the overall cure rate was 89%. Ten (15%) patients had a SAE within 12 weeks post-FMT, of which eight were hospitalizations. Two deaths occurred within 12 weeks of FMT, one of which was the result of aspiration during sedation for FMT administered via colonoscopy; the other was unrelated to FMT. None suffered infections definitely related to FMT, but one patient developed unrelated infection and two had self-limited diarrheal illness, which were probably unrelated, and for which no causal organism was identified. Three IBD patients (9%) experienced disease flare post-FMT. Two ulcerative colitis (UC) patients underwent colectomy related to course of UC >100 days after FMT. One patient had a superficial mucosal tear caused by the FMT colonoscopy and four patients reported mild, self limited abdominal discomfort post-FMT. Conclusion: This series demonstrates effective use of FMT for CDI in IC patients with few SAE or related AE. Importantly, there were no infectious complications in these high-risk patients. Further prospective studies of FMT in IC patients are needed to confirm safety and efficacy in this population. Disclosure - Dr. Khoruts-Research Support: CIPAC, Ltd Dr. Brandt-Speaker's Bureau/Research Support: Optimer Pharmaceuticals, Inc. Dr. Gordon-Speaker: Cubist.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».