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🌱來自: fecal microbiota transplantation

Recommendations from Professional Organizations of Fecal Microbiota Transplantation

• Infectious Diseases Society of America/Society for Healthcare Epidemiology of America (IDSA/SHEA)
• fecal microbiota transplantation (FMT) recommended in adult patients with ≥ 2 recurrences of Clostridioides (Clostridium) difficile infection (CDI) who have failed appropriate antibiotic treatments
• consider FMT in pediatric patients with recurrent CDI after standard antibiotic treatments
• Reference - [Clin Infect Dis 2018 Mar 19;66(7):e1][10][full-text][11], [Clin Infect Dis 2021 Sep 7;73(5):e1029][12]

European Society of Clinical Microbiology and Infectious Diseases (ESCMID) recommendations on use of fecal microbiota transplantation (FMT) in management of Clostridioides difficile infection (CDI) in adults * consider fecal microbiota transplantation (FMT) in patients with severe complicated CDI that have deteriorated despite CDI antibiotic treatment and surgery is not feasible, with decisions made case-by-case by multidisciplinary team ([ESCMID Weak recommendation, Very low-quality evidence][13]) * consider FMT after standard-of-care antibiotic pre-treatment in patients with multiple recurrence( [ESCMID Weak recommendation, Moderate-quality evidence][14]) * adequate multidisciplinary risk assessment needed * FMT products should go through standardized preparation and screening * Reference - [Clin Microbiol Infect 2021 Dec;27 Suppl 2:S1][15]

• British Society of Gastroenterology/Healthcare Infection Society (BSG/HIS) recommendations on FMT for C. difficile infection
  • recipient selection
    • CDI history
      • offer FMT to patients with recurrent CDI, including ([BSG/HIS Strong recommendation, High-quality evidence][16])
        • patients with ≥ 2 recurrences of C. difficile infection OR
        • patients with 1 recurrence and risk factors for further recurrences, such as severe/complicated CDI
      • strongly consider FMT in patients with refractory CDI ([BSG/HIS Strong recommendation, Moderate-quality evidence][17])
    • treatment history
      • do not offer FMT as initial therapy for CDI ([BSG/HIS Strong recommendation, Low-quality evidence][18])
      • consider FMT for recurrent CDI only after ([BSG/HIS Strong recommendation, Low-quality evidence][19])
        • symptom recurrence after resolution of an episode of CDI treated with ≥ 10 days of appropriate antimicrobial therapy
        • consideration of treatment with extended/pulsed vancomycin and/or fidaxomicin
        • consideration of treatment with medications associated with reduced risk of recurrence (such as, fidaxomicin and bezlotoxumab) in patients with severe or complicated CDI
    • comorbidities and immunosuppression
      • avoid FMT in patients with history of anaphylactic food allergy ([BSG/HIS Strong recommendation, Very low-quality evidence][20])
      • consider FMT with caution in patients with CDI and decompensated chronic liver disease ([BSG/HIS Weak recommendation, Very low-quality evidence][21])
      • offer FMT to patients with recurrent CDI and inflammatory bowel disease (IBD) with counselling on risks of IBD exacerbation ([BSG/HIS Strong recommendation, Moderate-quality evidence][22])
      • in patients with immunosuppression or immunocompromise
        • offer FMT with caution ([BSG/HIS Strong recommendation, Moderate-quality evidence][23])
        • for immunocompromised recipients at risk of severe infection if exposed to cytomegalovirus or Epstein-Barr virus, choose donor negative for these viruses ([BSG/HIS Strong recommendation, Very low-quality evidence][24])
      • offer FMT to appropriate patients with recurrent CDI regardless of other comorbidities ([BSG/HIS Strong recommendation, Moderate-quality evidence][25])
  • give further antimicrobial treatment for CDI for ≥ 72 hours prior to FMT ([BSG/HIS Strong recommendation, Low-quality evidence][26])
  • use of banked, frozen FMT is preferred over fresh preparations for treatment of recurrent CDI infection ([BSG/HIS Strong recommendation, High-quality evidence][27])
    • frozen FMT material has a maximum shelf life of 6 months from preparation when stored at -80 degrees C (-112 degrees F) (recommended) ([BSG/HIS Strong recommendation, Low-quality evidence][28])
    • consider thawing frozen samples at ambient temperature and use within 6 hours of thawing ([BSG/HIS Weak recommendation, Low-quality evidence][29])
    • avoid thawing frozen samples in warm water baths due to risks of cross-contamination and reduced bacterial viability ([BSG/HIS Weak recommendation, Very low-quality evidence][30])
  • follow best practices for prevention of further transmission of CDI during administration of FMT, including enteric precautions and sporicidal treatment of endoscope and other instruments ([BSG/HIS Strong recommendation, High-quality evidence][31])
  • cure and treatment failure definitions
    • record decision regarding cure/remission during follow-up, however, there is no universal definition and clinicians should decide on a case-by-case basis ([BSG/HIS Strong recommendation, Very low-quality evidence][32])
    • define treatment failure/recurrence on a case-by-case basis and routine testing for C. difficile toxin after FMT is not recommended, but may be considered in patients with persistent symptoms or suspected relapse ([BSG/HIS Strong recommendation, Low-quality evidence][33])
  • Reference - BSG/HIS guideline on use of fecal microbiota transplant as treatment for recurrent or refractory C. difficile infection ([Gut 2018 Nov;67(11):1920][34][PDF][35])

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title:Recommendations from Professional Organizations of Fecal Microbiota Transplantation date: “2023-02-02” enableToc: false

Info

🌱來自: fecal microbiota transplantation

Recommendations from Professional Organizations of Fecal Microbiota Transplantation

• Infectious Diseases Society of America/Society for Healthcare Epidemiology of America (IDSA/SHEA)

  • fecal microbiota transplantation (FMT) recommended in adult patients with ≥ 2 recurrences of Clostridioides (Clostridium) difficile infection (CDI) who have failed appropriate antibiotic treatments ([IDSA/SHEA Strong recommendation, Moderate-quality evidence][8])
  • consider FMT in pediatric patients with recurrent CDI after standard antibiotic treatments ([IDSA/SHEA Weak recommendation, Very low-quality evidence][9])
  • Reference - [Clin Infect Dis 2018 Mar 19;66(7):e1][10][full-text][11], [Clin Infect Dis 2021 Sep 7;73(5):e1029][12]

• Evidence Updated 29 Nov 2022

  European Society of Clinical Microbiology and Infectious Diseases (ESCMID) recommendations on use of fecal microbiota transplantation (FMT) in management of Clostridioides difficile infection (CDI) in adults

  • consider fecal microbiota transplantation (FMT) in patients with severe complicated CDI that have deteriorated despite CDI antibiotic treatment and surgery is not feasible, with decisions made case-by-case by multidisciplinary team ([ESCMID Weak recommendation, Very low-quality evidence][13])
  • consider FMT after standard-of-care antibiotic pre-treatment in patients with multiple recurrence( [ESCMID Weak recommendation, Moderate-quality evidence][14])
    • adequate multidisciplinary risk assessment needed
    • FMT products should go through standardized preparation and screening
  • Reference - [Clin Microbiol Infect 2021 Dec;27 Suppl 2:S1][15]

• British Society of Gastroenterology/Healthcare Infection Society (BSG/HIS) recommendations on FMT for C. difficile infection

  • recipient selection
    • CDI history
      • offer FMT to patients with recurrent CDI, including ([BSG/HIS Strong recommendation, High-quality evidence][16])
        • patients with ≥ 2 recurrences of C. difficile infection OR
        • patients with 1 recurrence and risk factors for further recurrences, such as severe/complicated CDI
      • strongly consider FMT in patients with refractory CDI ([BSG/HIS Strong recommendation, Moderate-quality evidence][17])
    • treatment history
      • do not offer FMT as initial therapy for CDI ([BSG/HIS Strong recommendation, Low-quality evidence][18])
      • consider FMT for recurrent CDI only after ([BSG/HIS Strong recommendation, Low-quality evidence][19])
        • symptom recurrence after resolution of an episode of CDI treated with ≥ 10 days of appropriate antimicrobial therapy
        • consideration of treatment with extended/pulsed vancomycin and/or fidaxomicin
        • consideration of treatment with medications associated with reduced risk of recurrence (such as, fidaxomicin and bezlotoxumab) in patients with severe or complicated CDI
    • comorbidities and immunosuppression
      • avoid FMT in patients with history of anaphylactic food allergy ([BSG/HIS Strong recommendation, Very low-quality evidence][20])
      • consider FMT with caution in patients with CDI and decompensated chronic liver disease ([BSG/HIS Weak recommendation, Very low-quality evidence][21])
      • offer FMT to patients with recurrent CDI and inflammatory bowel disease (IBD) with counselling on risks of IBD exacerbation ([BSG/HIS Strong recommendation, Moderate-quality evidence][22])
      • in patients with immunosuppression or immunocompromise
        • offer FMT with caution ([BSG/HIS Strong recommendation, Moderate-quality evidence][23])
        • for immunocompromised recipients at risk of severe infection if exposed to cytomegalovirus or Epstein-Barr virus, choose donor negative for these viruses ([BSG/HIS Strong recommendation, Very low-quality evidence][24])
      • offer FMT to appropriate patients with recurrent CDI regardless of other comorbidities ([BSG/HIS Strong recommendation, Moderate-quality evidence][25])
  • give further antimicrobial treatment for CDI for ≥ 72 hours prior to FMT ([BSG/HIS Strong recommendation, Low-quality evidence][26])
  • use of banked, frozen FMT is preferred over fresh preparations for treatment of recurrent CDI infection ([BSG/HIS Strong recommendation, High-quality evidence][27])
    • frozen FMT material has a maximum shelf life of 6 months from preparation when stored at -80 degrees C (-112 degrees F) (recommended) ([BSG/HIS Strong recommendation, Low-quality evidence][28])
    • consider thawing frozen samples at ambient temperature and use within 6 hours of thawing ([BSG/HIS Weak recommendation, Low-quality evidence][29])
    • avoid thawing frozen samples in warm water baths due to risks of cross-contamination and reduced bacterial viability ([BSG/HIS Weak recommendation, Very low-quality evidence][30])
  • follow best practices for prevention of further transmission of CDI during administration of FMT, including enteric precautions and sporicidal treatment of endoscope and other instruments ([BSG/HIS Strong recommendation, High-quality evidence][31])
  • cure and treatment failure definitions
    • record decision regarding cure/remission during follow-up, however, there is no universal definition and clinicians should decide on a case-by-case basis ([BSG/HIS Strong recommendation, Very low-quality evidence][32])
    • define treatment failure/recurrence on a case-by-case basis and routine testing for C. difficile toxin after FMT is not recommended, but may be considered in patients with persistent symptoms or suspected relapse ([BSG/HIS Strong recommendation, Low-quality evidence][33])
  • Reference - BSG/HIS guideline on use of fecal microbiota transplant as treatment for recurrent or refractory C. difficile infection ([Gut 2018 Nov;67(11):1920][34][PDF][35])