Stool substitute transplant therapy for the eradication of Clostridium difficile infection: 'RePOOPulating' the gut

被引:512
作者
Petrof, Elaine O. [1 ]
Gloor, Gregory B. [2 ]
Vanner, Stephen J. [1 ]
Weese, Scott J. [3 ]
Carter, David [4 ]
Daigneault, Michelle C. [5 ]
Brown, Eric M. [5 ]
Schroeter, Kathleen [5 ]
Allen-Vercoe, Emma [5 ]
机构
[1] Queens Univ, Kingston Gen Hosp, GIDRU Wing, Dept Med, Kingston, ON K7L 2V7, Canada
[2] Univ Western Ontario, Dept Biochem, London, ON N6A 3K7, Canada
[3] Univ Guelph, Dept Pathobiol, Guelph, ON N1G 2W1, Canada
[4] London Reg Genom Ctr, Robarts Res Inst, London, ON N6A 5K8, Canada
[5] Univ Guelph, Dept Mol & Cellular Biol, Guelph, ON N1G 2W1, Canada
来源
MICROBIOME | 2013年 / 1卷
关键词
Clostridium difficile; Fecal bacteriotherapy; Probiotics; Gut microbiome;
D O I
10.1186/2049-2618-1-3
中图分类号
Q93 [微生物学];
学科分类号
071005 ; 100705 ;
摘要
Background: Fecal bacteriotherapy ('stool transplant') can be effective in treating recurrent Clostridium difficile infection, but concerns of donor infection transmission and patient acceptance limit its use. Here we describe the use of a stool substitute preparation, made from purified intestinal bacterial cultures derived from a single healthy donor, to treat recurrent C. difficile infection that had failed repeated standard antibiotics. Thirty-three isolates were recovered from a healthy donor stool sample. Two patients who had failed at least three courses of metronidazole or vancomycin underwent colonoscopy and the mixture was infused throughout the right and mid colon. Pre-treatment and post-treatment stool samples were analyzed by 16 S rRNA gene sequencing using the Ion Torrent platform. Results: Both patients were infected with the hyper virulent C. difficile strain, ribotype 078. Following stool substitute treatment, each patient reverted to their normal bowel pattern within 2 to 3 days and remained symptom-free at 6 months. The analysis demonstrated that rRNA sequences found in the stool substitute were rare in the pre-treatment stool samples but constituted over 25% of the sequences up to 6 months after treatment. Conclusion: This proof-of-principle study demonstrates that a stool substitute mixture comprising a multi-species community of bacteria is capable of curing antibiotic-resistant C. difficile colitis. This benefit correlates with major changes in stool microbial profile and these changes reflect isolates from the synthetic mixture.
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页数:12
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