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Infecção por Clostridium difficile e o tratamento da sua recorrência : eficácia de terapia de transplantação de flora intestinal vs. Vancomicina : revisão
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Resumo(s)
A infecção por Clostridium difficile (CDI) é um problema global. A sua incidência e virulência tem vindo a aumentar, ao surgirem novas estirpes mais devastadoras. A CDI recorrente é outra situação preocupante que também tem aumentado, constituíndo um desafio a nível terapêutico, além da redução drástica da qualidade de vida destes pacientes. O risco de recorrência após o primeiro episódio é cerca de 20-30%. Após a primeira recorrência já é de 40-60%, aumentando o risco quanto mais episódios tiver. A terapêutica actual mostra-se inadequada e pouco eficaz, o que levou à necessidade de procurar alternativas à vancomicina (tratamento standard). A terapia de transplantação de flora intestinal (FMT) permite restaurar o equilíbrio da flora comensal, combatendo a disbacteriose. Esta técnica é segura, barata, com poucos efeitos adversos. A sua indicação é para doentes com múltiplas recorrências de CDI ou CDI grave, tendo sido incluída nas guidelines europeias e americanas. De acordo com vários estudos, a FMT demonstrou ser eficaz, com uma taxa de cura superior a 90%.Num ensaio clínico recente, mostrou ser mais eficaz do que a vancomicina, com 94% de eficácia. Porém, são necessários mais estudos para corroborar este ensaio, dado ser o único existente.
CDI is a global problem. Its incidence, virulence has been increasing as new hipervirulent strains emerge. Recurrent CDI another major concern, which has been increasing as well. Its treatment is challenging and it causes a significant downturn in the quality of life. The risk of recurrence after the first episode is 20-30%. After the first recurrence, the risk of having another episode is 40-60%, and it can worsen with further recurrences. The standard antibiotic treatment regimens (vancomycin) have shown to be less effective, which led to the search of alternative therapies. Fecal microbiota transplantation (FMT) restores the balance gut microbiota, resolving dysbiosis. This technic is safe, inexpensive, with few adverse reactions. It is indicated to patients with recurrent CDI (with multiple episodes) or severe CDI. FMT has been recently included in European and American guidelines. According to several reviews, FMT has shown its effectiveness with high cure rates (>90%). In a recent randomized controlled trial, FMT has proved its superiority compared to vancomycin, with 94% efficacy. However, further studies are necessary to backup this information, since it is the only one performed to date.
CDI is a global problem. Its incidence, virulence has been increasing as new hipervirulent strains emerge. Recurrent CDI another major concern, which has been increasing as well. Its treatment is challenging and it causes a significant downturn in the quality of life. The risk of recurrence after the first episode is 20-30%. After the first recurrence, the risk of having another episode is 40-60%, and it can worsen with further recurrences. The standard antibiotic treatment regimens (vancomycin) have shown to be less effective, which led to the search of alternative therapies. Fecal microbiota transplantation (FMT) restores the balance gut microbiota, resolving dysbiosis. This technic is safe, inexpensive, with few adverse reactions. It is indicated to patients with recurrent CDI (with multiple episodes) or severe CDI. FMT has been recently included in European and American guidelines. According to several reviews, FMT has shown its effectiveness with high cure rates (>90%). In a recent randomized controlled trial, FMT has proved its superiority compared to vancomycin, with 94% efficacy. However, further studies are necessary to backup this information, since it is the only one performed to date.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2015
Palavras-chave
Clostridium difficile Infecções por Clostridium Microbioma gastrointestinal Vancomicina