Iqbal Umair, Anwar Hafsa, Karim Muhammad A
Department of Internal Medicine, Bassett Medical Center, Cooperstown, New York, USA.
Jinnah Sindh Medical University.
Eur J Gastroenterol Hepatol. 2018 Jul;30(7):730-734. doi: 10.1097/MEG.0000000000001147.
Fecal microbial transplantation (FMT) has been shown to be effective for the treatment of recurrent clostridium difficile infection (CDI). The efficacy and safety of freeze-dried encapsulated FMT for the treatment of recurrent CDI is unclear. We performed a systematic review to evaluate and analyze the current evidence in this respect.
A systematic literature search was performed using the PubMed, Embase, and Medline databases until December 2017 to identify all original studies that investigated the role of administration of encapsulated FMT in recurrent CDI. The study included patients of all ages. Two independent reviewers extracted data and assessed the quality of publications; a third investigator resolved any discrepancies.
A total of six studies, five case series and one randomized-controlled trial, were included in this review. Overall, 341 patients completed treatment with encapsulated FMT. Only three major adverse events were reported and no deaths occurred directly related to FMT. In all, 285 patients responded to the first treatment, with no recurrence during the specified follow-up period set to meet the primary endpoint. Forty-two patients underwent a second treatment, with resolution of symptoms in 28 patients. At least five patients were reported to undergo a third treatment, with resolution in three of them. Only one patient was reported to have received four treatments without long-term resolution of symptoms.
Low-quality to moderate-quality evidence showed that encapsulated FMT is safe and cost-effective for the treatment and prevention of recurrent CDI. Its efficacy is not inferior to FMT performed through the nonoral route. Randomized-controlled trials are necessary to compare its efficacy with oral antimicrobial drugs and also to evaluate the potential adverse effects associated with the treatment.
粪便微生物移植（FMT）已被证明对治疗复发性艰难梭菌感染（CDI）有效。冻干封装的FMT治疗复发性CDI的疗效和安全性尚不清楚。我们进行了一项系统评价，以评估和分析这方面的现有证据。
使用PubMed、Embase和Medline数据库进行系统的文献检索，直至2017年12月，以确定所有调查封装FMT在复发性CDI中作用的原始研究。该研究纳入了所有年龄段的患者。两名独立的审阅者提取数据并评估出版物的质量；第三名研究者解决任何分歧。
本评价共纳入六项研究，五项病例系列研究和一项随机对照试验。总体而言，341例患者完成了封装FMT治疗。仅报告了3例主要不良事件，未发生与FMT直接相关的死亡。总共有285例患者对首次治疗有反应，在设定的符合主要终点的特定随访期内无复发。42例患者接受了第二次治疗，28例症状缓解。据报道至少有5例患者接受了第三次治疗，其中3例症状缓解。仅报告1例患者接受了四次治疗但症状未长期缓解。
低质量至中等质量的证据表明，封装FMT治疗和预防复发性CDI安全且具有成本效益。其疗效不低于非口服途径的FMT。有必要进行随机对照试验，以比较其与口服抗菌药物的疗效，并评估与该治疗相关的潜在不良反应。
