RESUMO
Clostridium difficile (CD) infection is increasing in frequency and severity in in-hospital and outpatient clinical settings, with a recurrence that can reach 30% after first episode. The recurrences are usually treated with longer courses of metronidazole or vancomycin. Other treatments have been used, such as probiotics, fidaxomicin, rifaximin, immunoglobulins and monoclonal antibodies against toxins A and B. Fecal microbiota transplantation (FMT) has emerged as a promising strategy in this group of patients, with effectiveness greater than 90%. We present the first case reported in Chile of this therapeutic strategy in a patient with Crohn's disease and recurrent CD infection who presented after the fecal transplantation an Escherichia coli bacteremia, suggesting the need for caution in the use of this strategy. 10 months after the FMT the patient presented a new episode of E. coli bacteremia and two episodes of diarrhea due to CD infection, treated both of them with vancomycin with good clinical response.
Assuntos
Terapia Biológica/efeitos adversos , Clostridioides difficile , Infecções por Clostridium/terapia , Infecções por Escherichia coli/etiologia , Fezes/microbiologia , Microbiota , Bacteriemia/microbiologia , Terapia Biológica/métodos , Chile , Doença de Crohn/microbiologia , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , TransplanteRESUMO
Clostridium difficile (CD) infection is increasing in frequency and severity in in-hospital and outpatient clinical settings, with a recurrence that can reach 30% after first episode. The recurrences are usually treated with longer courses of metronidazole or vancomycin. Other treatments have been used, such as probiotics, fidaxomicin, rifaximin, immunoglobulins and monoclonal antibodies against toxins A and B. Fecal microbiota transplantation (FMT) has emerged as a promising strategy in this group of patients, with effectiveness greater than 90%. We present the first case reported in Chile of this therapeutic strategy in a patient with Crohn's disease and recurrent CD infection who presented after the fecal transplantation an Escherichia coli bacteremia, suggesting the need for caution in the use of this strategy. 10 months after the FMT the patient presented a new episode of E. coli bacteremia and two episodes of diarrhea due to CD infection, treated both of them with vancomycin with good clinical response.
La infección por Clostridium difficile (CD) está aumentando en frecuencia y gravedad tanto a nivel intrahospitalario como ambulatorio, con una recurrencia que puede alcanzar hasta 30% después de un primer episodio. Los cuadros recurrentes son generalmente tratados con cursos prolongados de metronidazol y/o vancomicina. Otras terapias han sido sugeridas como el uso de probióticos, fidaxomicina, rifaximina, inmunoglobulina y anticuerpos monoclonales para toxina A y B. El trasplante de microbiota fecal (TMF) ha emergido como una estrategia promisoria en este grupo de pacientes con una efectividad mayor a 90%. Presentamos el primer caso reportado en Chile de esta estrategia terapéutica en un paciente con enfermedad de Crohn y CD recurrente, quien presentó una bacteriemia por Escherichia coli post-TMF, sugiriendo la necesidad de tener precaución con el uso de esta estrategia. El paciente presentó a los 10 meses post-TMF un nuevo episodio de bacteriemia por E. coli y dos episodios de diarrea por CD siendo tratados ambos cuadros con vancomicina con buena respuesta clínica.