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Washed Microbiota Transplantation as a Rescue Therapy for Refractory Unidentified Pathogen Intestinal Infections:

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Unidentified pathogen intestinal infections (UPIIs) are challenging. Washed microbiota transplantation (WMT) showed a 63.0% clinical response rate one month post-treatment, suggesting its potential for refractory UPIIs.

Keywords:
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Area of Science:

  • Gastroenterology
  • Infectious Diseases
  • Microbiome Therapeutics

Background:

  • Unidentified pathogen intestinal infections (UPIIs) present a significant clinical challenge due to the lack of identifiable causative agents, often resulting in prolonged and antibiotic-refractory illness.
  • Patients with UPIIs frequently experience severe symptoms, including the need for intensive care and the development of multiple organ dysfunction syndrome.

Purpose of the Study:

  • To evaluate the efficacy and safety of washed microbiota transplantation (WMT) as a therapeutic option for patients diagnosed with UPIIs.
  • To identify baseline risk factors influencing the clinical response to WMT in UPII patients.

Main Methods:

  • A nationwide retrospective study was conducted using prospective cohorts in China from September 2015 to February 2025.
  • Included patients were diagnosed with UPIIs and subsequently underwent WMT. The primary outcome was the clinical response rate at one month post-WMT.
  • Multivariate analysis and logistic regression were used to identify risk factors and develop a predictive nomogram for clinical non-response.

Main Results:

  • Out of 81 included patients, 71.6% were bedridden, 46.9% required ICU admission, and 51.9% had multiple organ dysfunction syndrome.
  • WMT achieved a one-month clinical response rate of 63.0% and a cure rate of 43.2%.
  • Adverse events (AEs) related to WMT occurred in 8.3% of cases. Baseline risk factors for non-response included WMT-related AEs, higher total abdominal symptom scores (TASS), and WHO performance status score ≥ 4.

Conclusions:

  • Washed microbiota transplantation (WMT) demonstrates favorable clinical outcomes in treating refractory UPIIs, providing cohort-based evidence for its use.
  • The study developed a nomogram to predict clinical non-response, aiding in patient selection and management.
  • Earlier consideration of WMT may be beneficial for patients with UPIIs, given its potential efficacy and acceptable safety profile.