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. 2016 Oct 18;20(1):332.
doi: 10.1186/s13054-016-1491-2.

Successful treatment with fecal microbiota transplantation in patients with multiple organ dysfunction syndrome and diarrhea following severe sepsis

Affiliations

Successful treatment with fecal microbiota transplantation in patients with multiple organ dysfunction syndrome and diarrhea following severe sepsis

Yanling Wei et al. Crit Care. .

Abstract

Background: The dysbiosis of intestinal microbiota plays an important role in the development of gut-derived infections, making it a potential therapeutic target against multiple organ dysfunction syndrome (MODS) after sepsis. However, the effectiveness of fecal microbiota transplantation (FMT) in treating this disease has been rarely investigated.

Methods: Two male patients, a 65-year-old and an 84-year-old, were initially diagnosed with cerebellar hemorrhage and cerebral infarction, respectively, after admission. During the course of hospitalization, both patients developed MODS, septic shock, and severe watery diarrhea. Demographic and clinical data were collected. Intestinal dysbiosis was confirmed by 16S rDNA-based molecular analysis of microbiota composition in fecal samples from the two patients. The two patients each received a single nasogastric infusion of sterile-filtered, pathogen-free feces from a healthy donor. Fecal samples were collected every two days post infusion to monitor changes in microbiota composition in response to treatment.

Results: Following FMT, MODS and severe diarrhea were alleviated in both patients. Their stool output and body temperature markedly declined and normalized. Significant modification of microbiota composition, characterized by a profound increase of commensals in the Firmicutes phylum and depletion of opportunistic organisms in the Proteobacteria phylum, was observed in both patients. Furthermore, we identified a reconstituted bacterial community enriched in Firmicutes and depleted of Proteobacteria that was associated with a decrease in the patients' fecal output and in the levels of plasma inflammation markers.

Conclusions: The outcome of treating two patients with FMT indicates that restoration of the intestinal microbiota barrier can alleviate the infection and modulate the immune response. These findings warrant further investigation of FMT as a putative new therapy for treating microbiota-related diseases such as MODS.

Keywords: Diarrhea; Fecal microbiota transplantation; MODS; Therapeutic efficacy.

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Figures

Fig. 1
Fig. 1
Changes in the gut microbiota of patients under fecal microbiota transplantation (FMT) treatment. a Clustering tree of weighted unifrac distances of microbial composition among different sampling time points. After receiving FMT, over time the gut microbiota of the two patients tended to approximate that of the donor. b Principal coordinate analysis (PCA) of the genus profile. The top four genera as the main contributors were determined and plotted by their loadings in these two components. d day
Fig. 2
Fig. 2
Predominant fecal microbiota composition in the donor and patients (case 1 and case 2) at the phyla level (a), the class level (b), the order level (c), the family level (d), and the genus level (e). Variations in the microbiota composition are shown at the representative time points in the days (d) following fecal microbiota transplantation
Fig. 3
Fig. 3
Volume of stool output in the two patients at time points (days) before and after fecal microbiota transplantation (Day 0)
Fig. 4
Fig. 4
Serum levels of IL-6 (a), C-reactive protein (CRP) (b), procalcitonin (PCT) (c) and erythrocyte sedimentation rate (ESR) (d) in the two patients (case 1 and case 2) before and after fecal microbiota transplantation (DAY 0)

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