<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>2341-4545</journal-id>
<journal-title><![CDATA[GE-Portuguese Journal of Gastroenterology]]></journal-title>
<abbrev-journal-title><![CDATA[GE Port J Gastroenterol]]></abbrev-journal-title>
<issn>2341-4545</issn>
<publisher>
<publisher-name><![CDATA[Sociedade Portuguesa de Gastrenterologia]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S2341-45452021000100056</article-id>
<article-id pub-id-type="doi">10.1159/000507263</article-id>
<title-group>
<article-title xml:lang="en"><![CDATA[Fecal Microbiota Transplant in a Patient Infected with Multidrug-Resistant Bacteria: A Case Report]]></article-title>
<article-title xml:lang="pt"><![CDATA[Transplante de microbiota fecal num doente infetado com microorganismos resistentes]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Gouveia]]></surname>
<given-names><![CDATA[Catarina]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Palos]]></surname>
<given-names><![CDATA[Carlos]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Pereira]]></surname>
<given-names><![CDATA[Patrícia]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Ramos]]></surname>
<given-names><![CDATA[Lídia Roque]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Cravo]]></surname>
<given-names><![CDATA[Marília]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Beatriz Ângelo Hospital Gastroenterology Department ]]></institution>
<addr-line><![CDATA[Loures ]]></addr-line>
<country>Portugal</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,Beatriz Ângelo Hospital Infection Control and Antimicrobial Resistance Department ]]></institution>
<addr-line><![CDATA[Loures ]]></addr-line>
<country>Portugal</country>
</aff>
<aff id="Af3">
<institution><![CDATA[,Beatriz Ângelo Hospital Microbiology Department ]]></institution>
<addr-line><![CDATA[Loures ]]></addr-line>
<country>Portugal</country>
</aff>
<pub-date pub-type="pub">
<day>27</day>
<month>02</month>
<year>2021</year>
</pub-date>
<pub-date pub-type="epub">
<day>27</day>
<month>02</month>
<year>2021</year>
</pub-date>
<volume>28</volume>
<numero>1</numero>
<fpage>56</fpage>
<lpage>61</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_arttext&amp;pid=S2341-45452021000100056&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_abstract&amp;pid=S2341-45452021000100056&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_pdf&amp;pid=S2341-45452021000100056&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract:  Introduction: There has been a growing interest in fecal microbiota transplantation (FMT) as a way to manipulate gut microbiota, with potential benefit in patients infected with multidrug-resistant (MDR) bacteria.  Case Presentation:  We present the case of an 87-year-old male with recurrent ascending cholangitis due to biliary atony and impaired biliary drainage after multiple biliary sphincterotomies and two papillary balloon dilations. In this context, a choledochoduodenostomy was performed, but the patient kept on having repeated episodes of acute cholangitis, resulting in multiple hospitalizations, every other week, with need of multiple broad-spectrum antibiotic courses, which led to bacteremias with MDR microorganisms. Several therapeutic strategies such as prophylactic antibiotics (including rifaximin), pre- and probiotics, prokinetics, and ursodeoxycholic acid were unsuccessfully attempted. After multidisciplinary case discussion, an FMT was proposed, with the aim of manipulating gut microbiota and decreasing MDR bacteremias. We first performed FMT via colonoscopy in September 2018, after which the patient still had 3 more hospitalizations for acute cholangitis, but isolated bacteria in blood cultures were resistant only to amoxicillin and clavulanic acid. Considering this apparent change in the microbial resistance profile, we performed a second FMT in January 2019 via the upper gastrointestinal route. During the next 4 months, the patient remained well. In April 2019, the patient relapsed again with three more episodes of cholangitis, for which we repeated the FMT via upper gastrointestinal endoscopy. No readmissions were observed during the next 4 months. All three FMTs were performed without complications.  Discussion and Conclusion: FMT seems to be a safe procedure and was effective in decreasing hospital admissions and changing the profile of MDR bacteria previously isolated from blood cultures.]]></p></abstract>
<abstract abstract-type="short" xml:lang="pt"><p><![CDATA[Resumo:  Introdução:  Tem havido um crescente interesse no transplante de microbiota fecal (TMF) como forma de manipular a microbiota intestinal, com potencial benefício em doentes infetados com microorganismos resistentes aos antibióticos (MRA).  Caso Clínico:  Apresentamos o caso de um homem de 87 anos de idade com colangite ascendente recorrente por atonia biliar e atraso na drenagem biliar após múltiplas esfincterotomias e duas esfincteroplastias com balão. Neste contexto, o doente foi submetido a uma coledocoduodenostomia, mantendo, no entanto, episódios recorrentes de colangite com elevada frequência (2 semanas), o que motivou hospitalizações múltiplas com necessidade de antibioterapia de largo-espectro, tendo como consequência bacteriémias por MRA. Várias estratégias terapêuticas, como antibioterapia profilática (incluindo rifaximina), pré e probióticos, procinéticos e ácido ursodesoxicólico, foram tentadas sem sucesso. Após discussão multidisciplinar do caso foi proposta a realização de um TMF, como forma de manipular a microbiota intestinal e diminuir as bacteriémias por MRA. Realizámos um TMF por via baixa (colonoscopia) em Setembro de 2018, após o qual o doente teve mais 3 hospitalizações por colangite, com bacteriémia a um microorganismo apenas resistente à amoxicilina e ácido clavulânico. Considerando a aparente mudança no perfil de resistência microbiana, realizamos um segundo TMF em Janeiro de 2019 por via alta (endoscopia), após o qual o doente permaneceu assintomático e sem novos internamentos durante 4 meses. Em Abril de 2019, o doente voltou a ter três episódios de bacteriémia com necessidade de internamento, pelo que repetimos a realização do TMF por via alta. O doente permaneceu sem novos internamentos durante 4 meses. Nenhum dos procedimentos teve complicações.  Discussão e Conclusão:  O TMF parece ser um procedimento seguro e foi eficaz na redução de internamentos hospitalares e na mudança do perfil de resistência dos microorganismos isolados nas hemoculturas.]]></p></abstract>
<kwd-group>
<kwd lng="en"><![CDATA[Fecal microbiota transplantation]]></kwd>
<kwd lng="en"><![CDATA[Multidrug-resistant bacteria]]></kwd>
<kwd lng="en"><![CDATA[Recurrent cholangitis]]></kwd>
<kwd lng="pt"><![CDATA[Transplante de microbiota fecal]]></kwd>
<kwd lng="pt"><![CDATA[Bacterias multi-resistentes]]></kwd>
<kwd lng="pt"><![CDATA[Colangite recorrente]]></kwd>
</kwd-group>
</article-meta>
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