背景:住院和抗生素治疗会使患者面临艰难梭菌感染的高风险,肠道微生物组的紊乱导致艰难梭菌增殖和相关症状,包括轻度,中度,或严重腹泻。艰难梭菌感染是具有挑战性的治疗,经常复发,仅在美国,每年就有近3万人死亡。在这里,我们提出了一个案例,其中SmartGut™,在家里,自行进行的基于测序的临床肠道筛查试验,用于确定腹泻恶化患者中艰难梭菌的存在。该病原体的鉴定和随后的治疗导致症状的显著改善。
方法:患者是一名29岁的白人女性,有严重肠易激综合征伴腹泻病史,痔疮切除术,肛门括约肌切开术并发肛周瘘和直肠周围脓肿,需要延长广谱抗生素疗程。2016年6月,她出现了间歇性艰难梭菌感染,需要继续使用抗生素。几个月后,她在家里用了一个,自我管理,肠道微生物测试,其中第一个对艰难梭菌的存在呈阴性,但是它检测到与肠易激综合征相关的微生物的相对丰度超出了健康参考范围。在艰难梭菌阴性结果后的2个月,她的胃肠道症状急剧恶化。第二次微生物组测试导致艰难梭菌阳性发现和持续异常的微生物参数,这导致主治医生将她转诊给胃肠病学家。另外的测试证实了具有毒素阳性菌株的艰难梭菌的存在。她立即接受治疗,在接下来的一周中,她的胃肠道症状明显改善。
结论:本病例报告提示,对于艰难梭菌感染高危患者,可能需要进行更频繁的DNA检测,尤其是肠易激综合征患者,以及接受胃肠手术和/或长期抗生素治疗的人。这份报告还表明,这种测试可以在家中有效地进行,自行进行的基于测序的临床肠道微生物筛查试验。需要进一步的研究来调查此处报道的观察结果是否外推到了更大的患者队列。
BACKGROUND: Hospitalization and antibiotic treatment can put patients at high risk for Clostridium difficile infection, where a disturbance of the gut microbiome allows for Clostridium difficile proliferation and associated symptoms, including mild, moderate, or severe diarrhea. Clostridium difficile infection is challenging to treat, often recurrent, and leads to almost 30,000 annual deaths in the USA alone. Here we present a
case where SmartGut™, an at-home, self-administered sequencing-based clinical intestinal screening test, was used to identify the presence of Clostridium difficile in a patient with worsening diarrhea. Identification of this pathogen and subsequent treatment led to a significant improvement in symptoms.
METHODS: The patient is a 29-year-old white woman with a history of severe irritable bowel syndrome with diarrhea, hemorrhoidectomy, and anal sphincterotomy complicated by a perianal fistula and perirectal abscesses that required extended courses of broad-spectrum antibiotics. In June 2016, she developed intermittent Clostridium difficile infections, which required continued antibiotic use. Months later she used an at-home, self-administered, intestinal microbial test, the first of which was negative for the presence of Clostridium difficile, but it detected the relative abundance of microbes associated with irritable bowel syndrome outside the healthy reference ranges. In the subsequent 2 months after the negative Clostridium difficile result, her gastrointestinal symptoms worsened dramatically. A second microbiome test resulted in a positive Clostridium difficile finding and continued abnormal microbial parameters, which led the treating physician to refer her to a gastroenterologist. Additional testing confirmed the presence of Clostridium difficile with a toxin-positive strain. She received treatment immediately and her gastrointestinal symptoms improved significantly over the next week.
CONCLUSIONS: This
case report suggests that more frequent DNA testing for Clostridium difficile infections may be indicated in patients that are at high-risk for Clostridium difficile infection, especially for patients with irritable bowel syndrome, and those who undergo gastrointestinal surgery and/or an extended antibiotic treatment. This report also shows that such testing could be effectively performed using at-home, self-administered sequencing-based clinical intestinal microbial screening tests. Further research is needed to investigate whether the observations reported here extrapolate to a larger cohort of patients.