Fecal microbiota transplantation-early steps on a long journey ahead

摘要

In 1958 Eiseman and colleagues reported a case series of 4 patients with pseudomembranous enteroco-litis promptly cured with a "simple therapeutic measure," fecal enemas.1 The condition was almost certainly caused by Clostridium difficile, a bacterium linked to pseudomembranous colitis only in the 1970s. However, the association with the usage of antibiotics was well recognized earlier and the fecal enema treatment was postulated to "re-establish the balance of nature" by "reintroduction of the bacteria, viruses, and bacteriophage normally found in the colon."1 In the 1950s pseudomembranous colitis was a dreadful disease with nearly 75% mortality. The 30-day mortality rate associated with surgical excision of the colon, which remains the current standard of care for antibiotic-refractory severe-complicated C. difficile infection (CDI), still stands at approximately 50%.2>3 In this issue of Gut Microbes, in their updated single center experience, Fischer and colleagues report 91% clinical cure of antibiotic-refractory severe-complicated CDI using FMT in 33 consecutive patients.4 For practitioners who have personally witnessed the remarkably rapid reversal of the deteriorating clinical course of C. difficile-triggered toxic megacolon following FMT,standard surgical care may no longer seem an ethically justifiable first treatment choice. In fact, fecal enemas were initially rapidly adopted in the care of pseudomembranous colitis in some centers following the Eiseman publication, only to retreat into near obscurity after introduction of vancomycin.5