Ianiro Gianluca, Maida Marcello, Burisch Johan, Simonelli Claudia, Hold Georgina, Ventimiglia Marco, Gasbarrini Antonio, Cammarota Giovanni
Gastroenterology Area, Fondazione Policlinico Universitario Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy.
Section of Gastroenterology, S. Elia - Raimondi Hospital, Caltanissetta, Italy.
United European Gastroenterol J. 2018 Oct;6(8):1232-1244. doi: 10.1177/2050640618780762. Epub 2018 Jun 3.
Protocols for treating recurrent infection (rCDI) through faecal microbiota transplantation (FMT) are still not standardised. Our aim was to evaluate the efficacy of different FMT protocols for rCDI according to routes, number of infusions and infused material.
MEDLINE, Embase, SCOPUS, Web of Science and the Cochrane Library were searched through 31 May 2017. Studies offering multiple infusions if a single infusion failed to cure rCDI were included. Data were combined through a random effects meta-analysis.
Fifteen studies (1150 subjects) were analysed. Multiple infusions increased efficacy rates overall (76% versus 93%) and in each route of delivery (duodenal delivery: 73% with single infusion versus 81% with multiple infusions; capsule: 80% versus 92%; colonoscopy: 78% versus 98% and enema: 56% versus 92%). Duodenal delivery and colonoscopy were associated, respectively, with lower efficacy rates ( = 0.039) and higher efficacy rates ( = 0.006) overall. Faecal amount ≤ 50 g ( = 0.006) and enema ( = 0.019) were associated with lower efficacy rates after a single infusion. The use of fresh or frozen faeces did not influence outcomes.
Routes, number of infusions and faecal dosage may influence efficacy rates of FMT for rCDI. These findings could help to optimise FMT protocols in clinical practice.
通过粪便微生物群移植（FMT）治疗复发性艰难梭菌感染（rCDI）的方案仍未标准化。我们的目的是根据途径、输注次数和输注材料评估不同FMT方案治疗rCDI的疗效。
检索截至2017年5月31日的MEDLINE、Embase、SCOPUS、Web of Science和Cochrane图书馆。纳入了那些如果单次输注未能治愈rCDI则提供多次输注的研究。通过随机效应荟萃分析合并数据。
分析了15项研究（1150名受试者）。多次输注总体上提高了治愈率（76%对93%），并且在每种给药途径中均如此（十二指肠给药：单次输注治愈率为73%，多次输注为81%；胶囊给药：80%对92%；结肠镜检查：78%对98%；灌肠：56%对92%）。总体而言，十二指肠给药和结肠镜检查分别与较低的治愈率（P = 0.039）和较高的治愈率（P = 0.006）相关。粪便量≤50 g（P = 0.006）和灌肠（P = 0.019）与单次输注后的较低治愈率相关。使用新鲜或冷冻粪便不影响治疗结果。
途径、输注次数和粪便剂量可能影响FMT治疗rCDI的治愈率。这些发现有助于在临床实践中优化FMT方案。
