Objective: The aim of this work was to describe the use of a combination of fidaxomicin and fecal microbiota therapy (FMT) in Clostridium difficile infection (CDI). Clinical Presentation and Intervention: A 78-year-old female, who was admitted for surgery due to acute diverticulitis caused by postoperative complications and broad antibiotic therapy, developed CDI-induced colitis. Despite the introduction of metronidazole and vancomycin therapy, her clinical condition continued to deteriorate. She was transferred to the intensive care unit where FMT followed by fidaxomicin were performed because her C-reactive protein and leucocyte levels remained elevated. Further clinical improvement and the resolution of colitis was observed. Conclusion: In this case, severe CDI colitis was successfully treated with the combination of FMT and fidaxomicin.
ZusammenfassungProbiotika werden häufig von Patienten mit chronisch entzündlichen Darmerkrankungen als begleitende Therapie verwendet. Auch wenn für eine positive Wirkung der Probiotika nur wenig Evidenz vorliegt, wird dieses Verhalten durch die Einschätzung als ein nebenwirkungsfreies Therapiekonzept begünstigt. In seltenen Fällen können Probiotika jedoch zu systemischen Infektionen in Form der Bakteriämien führen. Wir berichten über einen Patienten mit Morbus Crohn und begleitender HIV-Infektion der unter einer Therapie mit Ustekinumab ein septisches Krankheitsbild entwickelte. Es zeigte sich eine Bakteriämie mit Lactobacillum lacti, Leuconostoc citreum und Leuconostoc lactis, die anamnestisch auf den Verzehr von selbstgemachtem Joghurt zurückgeführt werden konnten. Die Verwendung von Probiotika bei CED-Patienten mit zusätzlichen immunkompromittierenden Faktoren stellt ein bislang schwer abschätzbares Risiko dar; von ihrer Anwendung sollte daher abgeraten werden.
Over the 21st century, inflammatory bowel disease (IBD) has become a global disease with no causal therapeutic options. Selective targeting of inflamed areas in the gastrointestinal tract could be an effective treatment circumventing severe side effects for healthy tissue. Our study demonstrates that the shape of polymeric nanostructures represents so far rarely addressed key to required tissue selectivity in the intestine. Ex vivo experiments on human colonic biopsies revealed that crosslinked wormlike micelles featuring a dense poly(ethylene oxide) (PEO) shell exclusively enter the inflamed human mucosa without affecting healthy tissue. Similarly designed spherical micelles (∼25 nm) or vesicles (∼120 nm) penetrate both tissues or were barely uptaken at all, respectively. Moreover, it was found that the particles colocalize with immune cells in the lamina propria facilitating a specific targeting of the main pro-inflammatory cells within the diseased human mucosa. These findings demonstrate an untapped potential in particle design and enable new vistas for an effective treatment of IBD.
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