Gastroenterology Clinic, Henry Dunant Hospital, Athens, Greece.
Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.
United European Gastroenterol J. 2019 Oct;7(8):1051-1063. doi: 10.1177/2050640619854587. Epub 2019 May 27.
Recurrence remains a challenge in infection (CDI), and in this field fecal microbiota transplantation (FMT) has attracted significant interest. Network meta-analysis (NWM) has been established as an evidence-synthesis tool that incorporates direct and indirect evidence in a collection of randomized controlled trials. So far no NWM exists concerning therapeutic interventions for recurrent CDI (rCDI).
In this NWM we assessed the comparative effectiveness of various therapies for rCDI to examine the efficacy rank order and determine the optimum therapeutic approach.
A Bayesian network meta-analysis was performed to investigate the efficacy rank order of rCDI interventions.
Six eligible RCTs were entered into an NWM. They included 348 rCDI patients, in whom seven therapeutic interventions were used, i.e. donor fecal microbiota transplantation (DFMT), vancomycin, fidaxomicin, vancomycin + DFMT, vancomycin + bowel lavage, autologous FMT and placebo. DFMT showed the highest efficacy in comparison with vancomycin [odds ratio (95% credible interval), 20.02 (7.05-70.03)] and fidaxomicin (22.01 (4.38-109.63)).
This NWM showed that DFMT is the optimum therapeutic approach for rCDI, as it was the most efficacious among various therapeutic interventions, particularly in comparison with commonly used antibiotics such as vancomycin or fidaxomicin.
在艰难梭菌感染（CDI）中，复发仍然是一个挑战，在该领域，粪便微生物群移植（FMT）引起了极大的兴趣。网络荟萃分析（NWM）已被确立为一种证据综合工具，可在一系列随机对照试验中纳入直接和间接证据。迄今为止，尚无针对复发性 CDI（rCDI）的治疗干预措施的 NWM。
在本次 NWM 中，我们评估了各种治疗 rCDI 的疗法的相对有效性，以检查疗效等级顺序并确定最佳治疗方法。
进行贝叶斯网络荟萃分析，以调查 rCDI 干预措施的疗效等级顺序。
六项合格的 RCT 被纳入 NWM。它们包括 348 名 rCDI 患者，其中使用了七种治疗干预措施，即供体粪便微生物群移植（DFMT）、万古霉素、非达霉素、万古霉素+DFMT、万古霉素+肠道灌洗、自体 FMT 和安慰剂。与万古霉素[比值比（95%可信区间），20.02（7.05-70.03）]和非达霉素相比，DFMT 的疗效最高[比值比（95%可信区间），20.02（7.05-70.03）]和非达霉素（22.01（4.38-109.63））。
本 NWM 表明，DFMT 是 rCDI 的最佳治疗方法，因为它是各种治疗干预措施中最有效的方法，特别是与万古霉素或非达霉素等常用抗生素相比。
