{"id":1991,"date":"2013-10-01T01:00:00","date_gmt":"2013-10-01T00:00:00","guid":{"rendered":"https:\/\/angh.net\/abstracts\/traitement-de-sauvetage-des-colites-pseudomembraneuses-refractaires-par-transplantation-de-microbiote-intestinal-tmi-une-alternative-a-la-colectomie\/"},"modified":"2018-10-20T18:40:12","modified_gmt":"2018-10-20T16:40:12","slug":"traitement-de-sauvetage-des-colites-pseudomembraneuses-refractaires-par-transplantation-de-microbiote-intestinal-tmi-une-alternative-a-la-colectomie","status":"publish","type":"post","link":"https:\/\/angh.net\/abstracts\/traitement-de-sauvetage-des-colites-pseudomembraneuses-refractaires-par-transplantation-de-microbiote-intestinal-tmi-une-alternative-a-la-colectomie\/","title":{"rendered":"Traitement de sauvetage des colites pseudomembraneuses r\u00e9fractaires par transplantation de microbiote intestinal (TMI) : une alternative \u00e0 la colectomie"},"content":{"rendered":"

2013<\/strong><\/p>\n

K. Aziz, D. Boutroux, M. Dartois-Hoguin, O. Nouel, V. Quentin, A. Signate, P. Zavadil . Service d\u2019H\u00e9pato-gastroent\u00e9rologie, Centre Hospitalier Yves Le Foll, Saint-Brieuc<\/em><\/p>\n

Gastroent\u00e9rologie <\/strong>– \u00a02013-05-15 –\u00a0CO –<\/p>\n

________________________________<\/p>\n

Introduction :
\nLa TMI est une approche th\u00e9rapeutique alternative des infections s\u00e9v\u00e8res \u00e0 Clostridium difficile (CD). Malgr\u00e9 l\u2019h\u00e9t\u00e9rog\u00e9n\u00e9it\u00e9 des protocoles d\u00e9crits dans la litt\u00e9rature, une efficacit\u00e9 spectaculaire est rapport\u00e9e chez des patients particuli\u00e8rement difficiles \u00e0 traiter (1). Un essai randomis\u00e9 a d\u00e9montr\u00e9 que l\u2019instillation duod\u00e9nale des selles issues d\u2019un donneur permet de restaurer la diversit\u00e9 du microbiote intestinal et de gu\u00e9rir les infections \u00e0 CD r\u00e9cidivantes (2). Cette premi\u00e8re \u00e9tude contr\u00f4l\u00e9e a l\u2019int\u00e9r\u00eat de rapporter un protocole th\u00e9rapeutique simple et reproductible.
\nObjectif :
\nRapporter notre exp\u00e9rience de la TMI dans le traitement des CPM s\u00e9v\u00e8res r\u00e9fractaires.
\nM\u00e9thodes :
\nLe donneur est un proche du cas index, \u00e2g\u00e9 de moins de 60 ans, n\u2019ayant pas re\u00e7u d\u2019antibiotique dans l\u2019ann\u00e9e. Le bilan pr\u00e9-th\u00e9rapeutique comprends un coproculture standard, une recherche des toxines de CD, un examen parasitologique des selles, et des s\u00e9rologies HIV, VHB, VHC, VHA, CMV, EBV, HTLV 1 et 2 et TPHA-VDRL. Une sonde naso-duod\u00e9nale est pos\u00e9e par endoscopie. Une pr\u00e9paration colique par 4L de PEG est administr\u00e9e la veille de la transplantation et les antibiotiques sont arr\u00eat\u00e9s. Les selles du donneur sont collect\u00e9es le jour m\u00eame, dilu\u00e9es dans 500 mL de s\u00e9rum sal\u00e9, homog\u00e9n\u00e9is\u00e9es et filtr\u00e9es. La solution est ensuite imm\u00e9diatement administr\u00e9e par la sonde naso-duod\u00e9nale.
\nR\u00e9sultats:
\nUne femme de 86 ans est op\u00e9r\u00e9e d\u2019un abc\u00e8s appendiculaire. Elle re\u00e7oit une antibioth\u00e9rapie \u00e0 large spectre par ceftriaxone, gentamicine et m\u00e9tronidazole. Elle quitte l\u2019h\u00f4pital avec un traitement par ciprofloxacine. Elle pr\u00e9sente un mois plus tard une CPM \u00e0 CD trait\u00e9e par vancomycine pendant 10 jours. Quinze jours plus tard, elle est r\u00e9-hospitalis\u00e9e pour une r\u00e9cidive s\u00e9v\u00e8re. Malgr\u00e9 un traitement optimis\u00e9 par m\u00e9tronidazole intraveineux (IV), vancomycine orale et immunoglobulines polyvalentes IV, son \u00e9tat se d\u00e9grade. Elle est r\u00e9cus\u00e9e pour la colectomie et une TMI est alors d\u00e9cid\u00e9e. L\u2019am\u00e9lioration clinique est spectaculaire et la patiente gu\u00e9rie sans r\u00e9cidive.
\nUn homme de 75 ans suivi pour un my\u00e9lome indolent \u00e0 IgM-kappa est trait\u00e9 pour une infection respiratoire par plusieurs antibiotiques successifs : amoxicilline et acide clavulanique, cotrimoxazole puis rovamycine. Il d\u00e9veloppe une diarrh\u00e9e aigu\u00eb et une colite \u00e0 CD est diagnostiqu\u00e9e. Il est admis en r\u00e9animation pour une d\u00e9faillance r\u00e9nale et respiratoire. Malgr\u00e9 un traitement par m\u00e9tronidazole IV et vancomycine orale, son \u00e9tat s\u2019aggrave. Le scanner abdominal et l\u2019endoscopie confirment le diagnostic de CPM s\u00e9v\u00e8re et le tableau se complique d\u2019une h\u00e9morragie digestive basse abondante. Une TMI est propos\u00e9e en alternative \u00e0 la colectomie. Le patient gu\u00e9rit et la recherche de CD est n\u00e9gative dans les selles \u00e0 J14.
\nConclusions:
\nLa TMI par instillation duod\u00e9nale est un traitement reproductible et particuli\u00e8rement efficace des infections \u00e0 CD graves r\u00e9fractaires. La TMI doit \u00eatre envisag\u00e9e dans ces situations critiques comme alternative \u00e0 la chirurgie.
\nR\u00e9f\u00e9rences:
\n1.\tGough E, Shaikh H, Manges AR. Systematic review of intestinal microbiota transplantation (fecal biotherapy) for recurrent Clostridium difficile infection. Clin Infect Dis 2011;53:994-1002.
\n2.\tVan Nood E, Vrieze A, Nieuwdorp M et al. Duodenal infusion of donor feces for recurrent Clostridium difficile. N Engl J Med 368:407-415<\/p>\n","protected":false},"excerpt":{"rendered":"

2013 K. Aziz, D. Boutroux, M. Dartois-Hoguin, O. Nouel, V. Quentin, A. Signate, P. Zavadil . Service d\u2019H\u00e9pato-gastroent\u00e9rologie, Centre Hospitalier Yves Le Foll, Saint-Brieuc Gastroent\u00e9rologie – \u00a02013-05-15 –\u00a0CO – ________________________________ Introduction : La TMI est une approche th\u00e9rapeutique alternative des infections s\u00e9v\u00e8res \u00e0 Clostridium difficile (CD). Malgr\u00e9 l\u2019h\u00e9t\u00e9rog\u00e9n\u00e9it\u00e9 des protocoles d\u00e9crits dans la litt\u00e9rature, une […]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[4],"tags":[24],"class_list":["post-1991","post","type-post","status-publish","format-standard","hentry","category-gastroenterologie","tag-24"],"yoast_head":"\nTraitement de sauvetage des colites pseudomembraneuses r\u00e9fractaires par transplantation de microbiote intestinal (TMI) : une alternative \u00e0 la colectomie - Abstracts des congr\u00e8s de l'ANGH<\/title>\n<meta name=\"description\" content=\"ANGH R\u00e9sum\u00e9s congr\u00e8s H\u00e9patologie Gastroent\u00e9romogie Hepatology Gastroenterology Etudes cliniques Clinical study\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/angh.net\/abstracts\/traitement-de-sauvetage-des-colites-pseudomembraneuses-refractaires-par-transplantation-de-microbiote-intestinal-tmi-une-alternative-a-la-colectomie\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Traitement de sauvetage des colites pseudomembraneuses r\u00e9fractaires par transplantation de microbiote intestinal (TMI) : une alternative \u00e0 la colectomie - 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