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Critical Care
Published in: Critical Care 1/2019

Open Access 01-12-2019 | Expectoration | Research

Rescue fecal microbiota transplantation for antibiotic-associated diarrhea in critically ill patients

Authors: Min Dai, Yafei Liu, Wei Chen, Heena Buch, Yi Shan, Liuhui Chang, Yong Bai, Chen Shen, Xiaoyin Zhang, Yufeng Huo, Dian Huang, Zhou Yang, Zhihang Hu, Xuwei He, Junyu Pan, Lili Hu, Xinfang Pan, Xiangtao Wu, Bin Deng, Zhifeng Li, Bota Cui, Faming Zhang

Published in: Critical Care | Issue 1/2019

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Abstract

Background

Antibiotic-associated diarrhea (AAD) is a risk factor for exacerbating the outcome of critically ill patients. Dysbiosis induced by the exposure to antibiotics reveals the potential therapeutic role of fecal microbiota transplantation (FMT) in these patients. Herein, we aimed to evaluate the safety and potential benefit of rescue FMT for AAD in critically ill patients.

Methods

A series of critically ill patients with AAD received rescue FMT from Chinese fmtBank, from September 2015 to February 2019. Adverse events (AEs) and rescue FMT success which focused on the improvement of abdominal symptoms and post-ICU survival rate during a minimum of 12 weeks follow-up were assessed.

Results

Twenty critically ill patients with AAD underwent rescue FMT, and 18 of them were included for analysis. The mean of Acute Physiology and Chronic Health Evaluation (APACHE) II scores at intensive care unit (ICU) admission was 21.7 ± 8.3 (range 11–37). Thirteen patients received FMT through nasojejunal tube, four through gastroscopy, and one through enema. Patients were treated with four (4.2 ± 2.1, range 2–9) types of antibiotics before and during the onset of AAD. 38.9% (7/18) of patients had FMT-related AEs during follow-up, including increased diarrhea frequency, abdominal pain, increased serum amylase, and fever. Eight deaths unrelated to FMT occurred during follow-up. One hundred percent (2/2) of abdominal pain, 86.7% (13/15) of diarrhea, 69.2% (9/13) of abdominal distention, and 50% (1/2) of hematochezia were improved after FMT. 44.4% (8/18) of patients recovered from abdominal symptoms without recurrence and survived for a minimum of 12 weeks after being discharged from ICU.

Conclusion

In this case series studying the use of FMT in critically ill patients with AAD, good clinical outcomes without infectious complications were observed. These findings could potentially encourage researchers to set up new clinical trials that will provide more insight into the potential benefit and safety of the procedure in the ICU.

Trial registration

ClinicalTrials.gov, Number NCT03895593. Registered 29 March 2019 (retrospectively registered).
Appendix
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Metadata
Title
Rescue fecal microbiota transplantation for antibiotic-associated diarrhea in critically ill patients
Authors
Min Dai
Yafei Liu
Wei Chen
Heena Buch
Yi Shan
Liuhui Chang
Yong Bai
Chen Shen
Xiaoyin Zhang
Yufeng Huo
Dian Huang
Zhou Yang
Zhihang Hu
Xuwei He
Junyu Pan
Lili Hu
Xinfang Pan
Xiangtao Wu
Bin Deng
Zhifeng Li
Bota Cui
Faming Zhang
Publication date
01-12-2019
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2019
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-019-2604-5

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