糞菌移植與重癥課件

CasepresentationA44-year-oldwoman，proximalgastrectomyandbilateraltruncalvagotomyforagastricneuroendocrinetumorthethirddaybloating,nauseaandvomitingthefourthday,waterydiarrhea.BP60/38mmHgLac8.2mmol/L

transferredtoICUthefifthday,39.6℃,ARDS,intubation,diarrheawasaggravated,greenish,wateryliquidexceeding1,800ml.septicshock,Sulbactam,ornidazole,NE.->VV-ECMO+CRRTConditiongraduallystabilized.VV-ECMOandCRRTwerestoppedonthe12thday,butdiarrheadidnotshownanyimprovement.Bloodcultures:Acinetobacterbaumannii

andEnterococcusfaecalis

->Imipenem,caspofungin,penicillinand/orlinezolid.Antibioticswerecontinueduntil28days,stillhadafever(38.3℃)waterystoolsreached2,855ml.bloodculture:Propionibacteriumacnes(瘡皰丙酸桿菌)

CRP103.3mg/LCasepresentationCasepresentationCasepresentation健康人患者FecalmicrobiotatransplantationCriticalCare(2015)19:37CriticalCare(2015)19:37CriticalCare(2015)19:37CriticalCare(2015)19:37ImmunomodulatoryeffectCriticalCare(2015)19:37Thisreportprovidesa

wonderfulexampleofaproof-of-conceptstudyindicatingthatFMTmayrepresentanidealtherapeuticalternative

tocontrolsystemicinflammationinpatientswithsepsis.CriticalCare(2015)19:37FecalMicrobiotaTransplantation

糞菌移植過去野葛芋毒、山中毒菌欲死者，并飲糞汁一升，即活。明朝李時珍所著《本草綱目》，記載用人糞治病的療方多達二十多種，也強調(diào)了發(fā)酵糞便上清液和新鮮糞清。現(xiàn)代的發(fā)展1958年，美國Eiseman首次報道FMT用于治療人偽膜性腸炎。1983年，瑞典Schwan首次報道通過灌腸FMT治療CDI獲得很好療效1989年，Bennet和Brinkman首次報道FMT治療UC取得了很好的療效2013年，NEJM發(fā)文示FMT治療復發(fā)性CDI的臨床對照研究證明FMT的療效顯著優(yōu)于萬古霉素?！禨cience》和《TIME》將其評為2013年生物醫(yī)學的十大突破之一。Gastroenterology,2013,145(5):946-953目前的應用小兒自閉癥Gastroenterology,2013,145(5):946-953Freshstoolsamplesfromhealthydonorsweretransportedtotheprocessinglaboratorieswithin5hoursofcollectionandstoredat5°CuntilfrozenorusedforFMT.Frozensuspensionswerekeptat?20°Cforamaximumof30daysandthawedovernightat25℃.CONCLUSIONS：AmongadultswithrecurrentorrefractoryCDI,theuseoffrozencomparedwithfreshFMTdidnotresultinworseproportionofclinicalresolutionofdiarrhea.GiventhepotentialadvantagesofprovidingfrozenFMT,itsuseisareasonableoptioninthissetting.JAMA.2016;315(2):142-149.不良事件Gastroenterology

2015;149:223–237我們不知道的Wedonotknowthepossiblelong-termsequelaeofchangingthemicrobiota,orevenifit