Background
Methods
Rescue FMT from Chinese fmtBank
Donor screening and management
Procedure of rescue FMT
Patients and data collection
The outcomes and definitions
Statistical analysis
Results
Characteristics of critically ill patients
Pt | Age (year) | Sex | Primary ICU diagnosis at the time of rescue FMT | APACHE II score | Extra-intestinal infection sites | Microbiological culture (sample) | Rescue FMT (delivery way, frequency) | FMT response | Adverse events (AEs) | Antibiotic resuming time after FMT | 12 weeks survival | Rescue success | ||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Pre-FMT | 3 days after FMT | 7 days after FMT | AEs (time after the first FMT) | Gradea | Causality between AEs and FMT | |||||||||||
1 | 25 | M | Cerebellar hemorrhage status post craniotomy, catheter associated bloodstream infection | 17 | 12 | Discharge | RT, blood | Klebsiella pneumoniae (blood) | Gastroscopy, one FMT | Diarrhea and abdominal distention improved | None | – | – | No use | Yes | Yes |
2 | 68 | M | Respiratory failure, pneumonia, post-CPR, cerebral infarction, postoperative prostate cancer, PD, GI bleeding | 28 | 26 | 24 | RT | Acinetobacter baumannii (sputum) | Nasojejunal tube, two FMTs | Abdominal distention and diarrhea improved | Hematuria (42 days) | – | Unrelated | 3 days | Yes | No |
Sudden cardiac arrest (69 days) | – | Unrelated | ||||||||||||||
Death (135 days) | – | Unrelated | ||||||||||||||
3 | 82 | F | Pulmonary infection, encephalatrophy | 11 | 11 | 11 | RT | Acinetobacter baumannii (sputum); Pseudomonas aeruginosa (sputum); negative (stool) | Nasojejunal tube, one FMT | Nonresponse | Death (52 days) | – | Unrelated | 13 days | No | No |
4 | 73 | M | Multiple trauma, pulmonary infection | 13 | Discharge | – | RT | Negative (blood) | Gastroscopy, one FMT | Diarrhea improved | Increased diarrhea frequency (< 1 day) | 2 | Probably related | 7 days | Yes | Yes |
5 | 17 | F | Septic shock, MODS, PMC, hypoxic-ischemic encephalopathy, post-CPR | 24 | 19 | 14 | Blood, RT, skin, UT | Acinetobacter baumannii (sputum), E. coli (blood); Candida albicans (stool), Pseudomonas aeruginosa (urine) | Nasojejunal tube, four FMTs | Nonresponse after the first FMT, diarrhea and abdominal distention improved after the third FMT | Increased diarrhea frequency (< 1 day) | 2 | Probably related | 8 h | Yes | Yes |
6 | 54 | F | Rheumatic heart disease, post-valve replacement | 32 | 34 | 34 | RT, blood, UT | Candida Albicans (sputum, urine, stool), Klebsiella pneumoniae (sputum), Enterobacter cloacae (sputum, blood), E. coli (urine), Enterococcus aureus (urine) | Nasojejunal tube, two FMTs | Hematochezia alleviated, diarrhea and abdominal pain improved | Abdominal pain (< 1 day) | 1 | Probably related | 29 days | Yes | Yes |
7 | 3 | M | Sepsis, septic encephalopathy, MODS, PMC, post-ileostomy | 25 | 31 | 22 | Brain, blood, skin | Candida albicans (stool), Saccharomyces cerevisiae Hansen (stool) | Nasojejunal tube, one FMT | Diarrhea cured, abdominal distention improved | Increased diarrhea frequency (< 1 day) | 1 | Probably related | 7 days | Yes | Yes |
8 | 27 | F | Infective endocarditis, pulmonary infection, septic shock, thoracic empyema, PMC, MODS | 39 | 38 | 39 | Heart, RT, thoracic cavity | Candida glabrata (stool) | Nasojejunal tube, two FMTs | Nonresponse | Increased diarrhea frequency (3 days) b | 3 | Probably related | Continued antibiotic use | No | No |
9 | 27 | F | Sepsis, PMC, SLE (severe, active phase, systemic lupus erythematosus), lupus nephritis, pneumonia | 12 | 12 | 12 | Blood, RT | Enterococcus faecium (blood), Pseudomonas aeruginosa (sputum) | Nasojejunal tube, two FMTs | Transient diarrhea exacerbation, then abdominal distention and diarrhea improved | Hospitalization due to herpes zoster (116 days) | – | Unrelated | 24 h | Yes | Yes |
10 | 91 | M | Peri-anal abscess, CHD, COPD, cerebral infarction, arrhythmia, atrial fibrillation, NYHA III, cholecystitis, gallstones | 20 | 18 | 18 | Anus, RT | Pseudomonas aeruginosa (sputum) | Nasojejunal tube, three FMTs | Diarrhea and abdominal distention improved | Death (23 days) | – | Unrelated | 14 days | No | No |
11 | 83 | M | COPDAE, respiratory failure, pulmonary encephalopathy, esophagus cancer, hypertension, DM | 35 | 23 | Died | RT | Acinetobacter baumannii (sputum) | Nasojejunal tube, one FMT | Diarrhea and abdominal distention improved | Death (4 days) | – | Unrelated | 20 h | No | No |
12 | 56 | M | Septic shock, brain stem infarction, MODS, upper GI bleeding, ischemic necrotizing enteritis? PMC? | 25 | 22 | Discharge | Blood, RT | Pseudomonas aeruginosa (blood, sputum) | Gastroscopy, one FMT | Diarrhea improved | Upper GI bleeding relapse (6 days) | – | Unrelated | 2 days | No | No |
Death (8 days) | – | Unrelated | ||||||||||||||
13 | 35 | F | Multiple venous thrombosis, abdominal cavity infection, GI bleeding, abdominal hypertension syndrome, PMC, pulmonary infection | 22 | Died | – | Abdominal cavity, blood, RT | Acinetobacter baumannii (blood, sputum) | Enema, four FMTs | Nonresponse | Death (3 days) | – | Unrelated | No use | No | No |
14 | 41 | M | Sepsis, septic shock, MODS, post-SAP, pancreatic pseudocyst with acute infection, pulmonary infection, UTI | 12 | 11 | 7 | Pancreas, blood, RT, UT | Acinetobacter baumannii (abdominal cavity effusion), Pseudomonas aeruginosa (abdominal cavity effusion), Serratia marcescens (abdominal cavity effusion) | Nasojejunal tube, two FMTs | Nonresponse | Abdominal pain (< 1 day) | 1 | Possibly related | 24 h | No | No |
Increased Serum amylase (< 1 day) | 1 | Possibly related | ||||||||||||||
Death (46 days) | – | Unrelated | ||||||||||||||
15 | 59 | M | Multiple trauma, septic shock, PMC, hypertension, CHD | 27 | 17 | 15 | RT, blood, UT | Acinetobacter baumannii (sputum, blood, urine, stool) | Nasojejunal tube, two FMTs | Diarrhea and abdominal distention improved | None | – | – | 8 h | Yes | Yes |
16 | 2 | M | Cardiac arrest, respiratory failure, bronchitis, CNS infection, severe sepsis, severe malnutrition | 7 | 6 | 7 | RT, CNS | Negative (blood, sputum, urine, stool) | Gastroscopy, two FMTs | Diarrhea improved but relapsed 8 days after rescue FMT | Fever (< 1 day) | 1 | Possibly related | 24 h | Yes | No |
17 | 69 | F | Post-radical resection of hilar cholangiocarcinoma, post-left hepatectomy | 7 | 7 | 7 | Stoma | Enterococcus aureus (stoma secretion) | Nasojejunal tube, one FMT | Nonresponse | None | – | – | 6 days | Yes | Yes |
18 | 56 | M | Septic shock, refractory CDI, multiple cerebral hemorrhage | 14 | 12 | Discharge | RT | Clostridium difficile (stool) | Nasojejunal tube, one FMT | Diarrhea, abdominal distention and abdominal pain improved | None | – | – | No use | Yes | Yes |