粪菌移植与重症

Case presentation,A 44-year-old woman，proximal gastrectomy and bilateral truncal vagotomy for a gastric neuroendocrine tumorthe third daybloating, nausea and vomiting the fourth day, watery diarrhea. BP 60/38 mmHg Lac 8.2 mmol/L transferred to ICUthe fifth day, 39.6 ,ARDS ,intubation ,diarrhea was aggravated, greenish, watery liquid exceeding 1,800 ml. septic shock ,Sulbactam, ornidazole,NE.-VV-ECMO+CRRT,Condition gradually stabilized. VV-ECMO and CRRT were stopped on the 12th day, but diarrhea did not shown any improvement .Blood cultures :Acinetobacter baumannii and Enterococcus faecalis -Imipenem, caspofungin, penicillin and/or linezolid.Antibiotics were continued until 28 days, still had a fever (38.3) watery stools reached 2,855 ml. blood culture :Propionibacterium acnes (疮疱丙酸杆菌) CRP 103.3 mg/L,Case presentation,Case presentation,Case presentation,健康人,患者,Fecal microbiota transplantation,Critical Care (2015) 19:37,Critical Care (2015) 19:37,Critical Care (2015) 19:37,Critical Care (2015) 19:37,Immunomodulatory effect,Critical Care (2015) 19:37,This report provides awonderful example of a proof-of-concept study indicating that FMT may represent an ideal therapeutic alternativeto control systemic inflammation in patients with sepsis.,Critical Care (2015) 19:37,Fecal Microbiota Transplantation粪菌移植,过去,野葛芋毒、山中毒菌欲死者，并饮粪汁一升，即活。,明朝李时珍所著本草纲目，记载用人粪治病的疗方多达二十多种，也强调了发酵粪便上清液和新鲜粪清。,现代的发展,1958 年，美国Eiseman 首次报道FMT 用于治疗人伪膜性肠炎。1983 年，瑞典Schwan 首次报道通过灌肠FMT 治疗CDI 获得很好疗效1989 年，Bennet 和Brinkman首次报道FMT 治疗UC取得了很好的疗效2013 年，NEJM发文示FMT 治疗复发性CDI的临床对照研究证明FMT 的疗效显著优于万古霉素。Science和TIME将其评为2013 年生物医学的十大突破之一。,Gastroenterology,2013,145 (5 ):946-953,目前的应用,小儿自闭症,Gastroenterology,2013,145 (5 ):946-953,Fresh stool samples from healthy donors were transported to the processing laboratories within 5 hours of collection and stored at 5C until frozen or used for FMT.Frozen suspensions were kept at 20C for a maximum of 30 days and thawed overnight at 25.CONCLUSIONS ：Among adults with recurrent or refractory CDI, the use of frozen compared with fresh FMT did not result in worse proportion of clinical resolution ofdiarrhea. Given the potential advantages of providing frozen FMT, its use is a reasonable option in this setting.,JAMA. 2016;315(2):142-149.,不良事件,Gastroenterology 2015;149:223237,我们不知道的,We do not know the possible long-term sequelae of changing the microbiota, or even if