2018年发布了首个英国胃肠病学会(BSG)和医疗保健感染学会(HIS)认可的粪便微生物群移植(FMT)指南。在过去的5年里,证据基础有了相当大的增长(包括来自大型国家FMT登记册的结果的公布),需要对文献进行更新的批判性审查和BSG/HISFMT指南的第二版。这些是根据国家卫生与护理卓越研究所认可的方法制作的,因此对英国的临床医生特别有意义,但旨在在国际上具有针对性。该指南的第二版已分为建议,针对某些做法的良好做法要点和建议。关于艰难梭菌感染(CDI)的FMT,重点关注领域围绕行政时机,增加封装的FMT制剂的临床经验和优化供体筛选。考虑到COVID-19大流行,后一个话题特别相关,以及FMT相关病原体传播导致的患者发病率和死亡率的病例。该指南还考虑了在非CDI环境中使用FMT(包括胃肠道和非胃肠道适应症)的最新文献,回顾相关随机对照试验。提供有关特殊领域的建议(包括富有同情心的FMT使用),以及关于FMT和微生物组疗法不断发展的景观的考虑。
The first British Society of Gastroenterology (BSG) and Healthcare Infection Society (HIS)-endorsed faecal microbiota transplant (FMT)
guidelines were published in 2018. Over the past 5 years, there has been considerable growth in the evidence base (including publication of outcomes from large national FMT registries), necessitating an updated critical review of the literature and a second edition of the BSG/HIS FMT
guidelines. These have been produced in accordance with National Institute for Health and Care Excellence-accredited methodology, thus have particular relevance for UK-based clinicians, but are intended to be of pertinence internationally. This second edition of the
guidelines have been divided into recommendations, good practice points and recommendations against certain practices. With respect to FMT for Clostridioides difficile infection (CDI), key focus areas centred around timing of administration, increasing clinical experience of encapsulated FMT preparations and optimising donor screening. The latter topic is of particular relevance given the COVID-19 pandemic, and cases of patient morbidity and mortality resulting from FMT-related pathogen transmission. The
guidelines also considered emergent literature on the use of FMT in non-CDI settings (including both gastrointestinal and non-gastrointestinal indications), reviewing relevant randomised controlled trials. Recommendations are provided regarding special areas (including compassionate FMT use), and considerations regarding the evolving landscape of FMT and microbiome therapeutics.