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Duodenal Infusion of Donor Feces for Recurrent Clostridium difficile.

Published date 2013 Jan 16

Duodenal Infusion of Donor Feces for Recurrent Clostridium difficile.

Recurrent C.ディフィシルのためのDonor Fecesの十二指腸Infusion。

Published date



N Engl J Med. 2013;


Els van Nood, Anne Vrieze, Max Nieuwdorp, Susana Fuentes, Erwin G Zoetendal, Willem M de Vos, Caroline E Visser, Ed J Kuijper, Joep F W M Bartelsman, Jan G P Tijssen, Peter Speelman, Marcel G W Dijkgraaf, Josbert J Keller


From the Departments of Internal Medicine (E.N., A.V., M.N., P.S.), Microbiology (C.E.V.), Gastroenterology (J.F.W.M.B., J.J.K.), and Cardiology (J.G.P.T.) and the Clinical Research Unit (M.G.W.D.), Academic Medical Center, University of Amsterdam, Amsterdam; the Laboratory of Microbiology, Wageningen University, Wageningen (S.F., E.G.Z., W.M.V.); the Department of Experimental and Medical Microbiology, Leiden University Medical Center, Leiden (E.J.K.); and the Department of Gastroenterology, Hagaziekenhuis, The Hague (J.J.K.) - all in the Netherlands; and the Department of Bacteriology and Immunology, Medical Faculty, University of Helsinki, Helsinki (W.M.V.).


Background Recurrent Clostridium difficile infection is difficult to treat, and failure rates for antibiotic therapy are high. We studied the effect of duodenal infusion of donor feces in patients with recurrent C. difficile infection. Methods We randomly assigned patients to receive one of three therapies: an initial vancomycin regimen (500 mg orally four times per day for 4 days), followed by bowel lavage and subsequent infusion of a solution of donor feces through a nasoduodenal tube; a standard vancomycin regimen (500 mg orally four times per day for 14 days); or a standard vancomycin regimen with bowel lavage. The primary end point was the resolution of diarrhea associated with C. difficile infection without relapse after 10 weeks. Results The study was stopped after an interim analysis. Of 16 patients in the infusion group, 13 (81%) had resolution of C. difficile-associated diarrhea after the first infusion. The 3 remaining patients received a second infusion with feces from a different donor, with resolution in 2 patients. Resolution of C. difficile infection occurred in 4 of 13 patients (31%) receiving vancomycin alone and in 3 of 13 patients (23%) receiving vancomycin with bowel lavage (P<0.001 for both comparisons with the infusion group). No significant differences in adverse events among the three study groups were observed except for mild diarrhea and abdominal cramping in the infusion group on the infusion day. After donor-feces infusion, patients showed increased fecal bacterial diversity, similar to that in healthy donors, with an increase in Bacteroidetes species and clostridium clusters IV and XIVa and a decrease in Proteobacteria species. Conclusions The infusion of donor feces was significantly more effective for the treatment of recurrent C. difficile infection than the use of vancomycin. (Funded by the Netherlands Organization for Health Research and Development and the Netherlands Organization for Scientific Research; Netherlands Trial Register number, NTR1177 .).


C.ディフィシル感染の消散は、バンコマイシン単独の投与を受けた13例の患者のうちの4例(31%)で、そして、腸洗浄(注入群による両群間比較のためのP < 0.001)によるバンコマイシンの投与を受けた13例の患者のうちの3例(23%)で生じた。

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