Quraishi M N, Widlak M, Bhala N, Moore D, Price M, Sharma N, Iqbal T H
Department of Gastroenterology, University Hospital Birmingham, Birmingham, UK.
Department of Gastroenterology, University Hospital Coventry and Warwickshire, Conventry, UK.
Aliment Pharmacol Ther. 2017 Sep;46(5):479-493. doi: 10.1111/apt.14201. Epub 2017 Jul 14.
Clostridium difficile infection (CDI) is the commonest nosocomial cause of diarrhoea. Faecal microbiota transplantation (FMT) is an approved treatment for recurrent or refractory CDI but there is uncertainty about its use.
To evaluate the efficacy of FMT in treating recurrent and refractory CDI and investigate outcomes from modes of delivery and preparation.
A systematic review and meta-analysis was performed. MEDLINE, EMBASE, CINAHL, Cochrane Library, trial registers and conference proceedings were searched. Studies on FMT in recurrent and refractory CDI were included. The primary outcome was clinical resolution with subgroup analyses of modes of delivery and preparation. Random effects meta-analyses were used to combine data.
Thirty seven studies were included; seven randomised controlled trials and 30 case series. FMT was more effective than vancomycin (RR: 0.23 95%CI 0.07-0.80) in resolving recurrent and refractory CDI. Clinical resolution across all studies was 92% (95%CI 89%-94%). A significant difference was observed between lower GI and upper GI delivery of FMT 95% (95%CI 92%-97%) vs 88% (95%CI 82%-94%) respectively (P=.02). There was no difference between fresh and frozen FMT 92% (95%CI 89%-95%) vs 93% (95%CI 87%-97%) respectively (P=.84). Administering consecutive courses of FMT following failure of first FMT resulted in an incremental effect. Donor screening was consistent but variability existed in recipient preparation and volume of FMT. Serious adverse events were uncommon.
Faecal microbiota transplantation is an effective treatment for recurrent and refractory Clostridium difficile infection, independent of preparation and route of delivery.
艰难梭菌感染（CDI）是医院获得性腹泻最常见的病因。粪便微生物群移植（FMT）是一种已获批准用于治疗复发性或难治性CDI的方法，但关于其应用仍存在不确定性。
评估FMT治疗复发性和难治性CDI的疗效，并研究不同给药方式和制剂的治疗效果。
进行了一项系统评价和荟萃分析。检索了MEDLINE、EMBASE、CINAHL、Cochrane图书馆、试验注册库和会议论文集。纳入了关于FMT治疗复发性和难治性CDI的研究。主要结局是临床缓解，并对给药方式和制剂进行亚组分析。采用随机效应荟萃分析合并数据。
纳入37项研究；7项随机对照试验和30项病例系列研究。在解决复发性和难治性CDI方面，FMT比万古霉素更有效（RR：0.23，95%CI 0.07 - 0.80）。所有研究的临床缓解率为92%（95%CI 89% - 94%）。FMT经下消化道给药和上消化道给药的临床缓解率存在显著差异，分别为95%（95%CI 92% - 97%）和88%（95%CI 82% - 94%）（P = 0.02）。新鲜FMT和冷冻FMT之间无差异，分别为92%（95%CI 89% - 95%）和93%（95%CI 87% - 97%）（P = 0.84）。首次FMT失败后给予连续疗程的FMT产生了累加效应。供体筛查一致，但受体准备和FMT剂量存在差异。严重不良事件并不常见。
粪便微生物群移植是治疗复发性和难治性艰难梭菌感染的有效方法，与制剂和给药途径无关。
