SNFGE SNFGE
 
Thématique :
- Intestin/Nutrition/Troubles fonctionnels
Originalité :
Très original
Solidité :
Très solide
Doit faire évoluer notre pratique :
Immédiatement
 
 
Nom du veilleur :
Professeur Frank ZERBIB
Coup de coeur :
 
 
Journal of the American Medical Association (JAMA)
  2016/01  
 
  2016 Jan 12;315(2):142-149  
  doi: 10.1001/jama.2015.18098.  
 
  Frozen vs Fresh Fecal Microbiota Transplantation and Clinical Resolution of Diarrhea in Patients With Recurrent Clostridium difficile Infection: A Randomized Clinical Trial.  
 
  Lee CH, Steiner T, Petrof EO, Smieja M, Roscoe D, Nematallah A, Weese JS, Collins S, Moayyedi P, Crowther M, Ropeleski MJ, Jayaratne P, Higgins D, Li Y, Rau NV, Kim PT  
  http://www.ncbi.nlm.nih.gov/pubmed/?term=Frozen+vs+Fresh+Fecal+Microbiota+Transplantation+and+Clinical+Resolution+of+Diarrhea+in+Patients+With+Recurrent+Clostridium+difficile+Infection%3A+A+Randomized+Clinical+Trial.  
 
 

Importance:

Clostridium difficile infection (CDI) is a major burden in health care and community settings. CDI recurrence is of particular concern because of limited treatment options and associated clinical and infection control issues. Fecal microbiota transplantation (FMT) is a promising, but not readily available, intervention.

Objective:

To determine whether frozen-and-thawed (frozen, experimental) FMT is noninferior to fresh (standard) FMT in terms of clinical efficacy among patients with recurrent or refractory CDI and to assess the safety of both types of FMT.

Design, Setting, and Participants:

Randomized, double-blind, noninferiority trial enrolling 232 adults with recurrent or refractory CDI, conducted between July 2012 and September 2014 at 6 academic medical centers in Canada.

Interventions:

Patients were randomly allocated to receive frozen (n = 114) or fresh (n = 118) FMT via enema.

Main Outcomes and Measures:

The primary outcome measures were clinical resolution of diarrhea without relapse at 13 weeks and adverse events. Noninferiority margin was set at 15%.

Results:

A total of 219 patients (n = 108 in the frozen FMT group and n = 111 in the fresh FMT group) were included in the modified intention-to-treat (mITT) population and 178 (frozen FMT: n = 91, fresh FMT: n = 87) in the per-protocol population. In the per-protocol population, the proportion of patients with clinical resolution was 83.5% for the frozen FMT group and 85.1% for the fresh FMT group (difference, -1.6% [95% CI, -10.5% to ∞]; P = .01 for noninferiority). In the mITT population the clinical resolution was 75.0% for the frozen FMT group and 70.3% for the fresh FMT group (difference, 4.7% [95% CI, -5.2% to ∞]; P < .001 for noninferiority). There were no differences in the proportion of adverse or serious adverse events between the treatment groups.

Conclusions and Relevance:

Among adults with recurrent or refractory CDI, the use of frozen compared with fresh FMT did not result in worse proportion of clinical resolution of diarrhea. Given the potential advantages of providing frozen FMT, its use is a reasonable option in this setting.

 
Question posée
 
Peut-on utiliser des selles congelées (et décongelées) pour la transplantation fécale dans les colites à Clostridium difficile récidivantes ?
 
Question posée
 
Oui, cette étude randomisée montre des résultats identiques obtenus avec des selles congelées et des selles fraiches administrées par lavement.
 
Commentaires

Cette étude est très importante car en pratique, l’utilisation de selles fraiches pose problème. La possibilité de congeler les selles permet de constituer des « banques de selles » sur lesquelles les examens appropriés auront été préalablement réalisés. Les résultats de cette étude vont favoriser le développement de cette technique. 

 
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