Dembrovszky Fanni, Gede Noémi, Szakács Zsolt, Hegyi Péter, Kiss Szabolcs, Farkas Nelli, Molnár Zsolt, Imrei Marcell, Dohos Dóra, Péterfi Zoltán
Medical School, Institute for Translational Medicine, University of Pécs, Pécs, Hungary.
János Szentágothai Research Center, University of Pécs, Pécs, Hungary.
Infect Dis Ther. 2021 Mar;10(1):201-211. doi: 10.1007/s40121-020-00356-9. Epub 2020 Oct 26.
Clostridioides difficile (formerly Clostridium) infection (CDI) is the most common cause of healthcare-associated diarrhea with high mortality and recurrence rate; furthermore, the treatment of recurrent cases is a challenge. In this network meta-analysis, we aimed to compare all available therapies against multiple recurrent CDI (mrCDI) and rank them by efficacy.
After a systematic search, randomized controlled trials (RCT) with any interventions against mrCDI were included. Data were extracted to the study database using Excel. Risk of bias assessment was performed with the Cochrane RoB 2 tool. The primary outcome was the clinical cure of CDI and the secondary outcome was the recurrence of CDI. A Bayesian method was performed to investigate the efficacy rank order of therapies. We registered our protocol with the Prospero Center for Reviews and Dissemination (registration no. CRD42020160365).
Six RCTs with seven interventions were included in the quantitative synthesis. According to the surface under the cumulative ranking curve values, fecal microbiota transplantation (FMT) after a short course of vancomycin therapy (83%) shows the highest efficacy for clinical cure. Tolevamer and vancomycin + FMT seemed to be the most effective in preventing recurrence (87% and 75%, respectively).
Vancomycin + FMT is perhaps the most effective option for the treatment and prevention of mrCDI, while tolevamer is also effective in preventing recurrence.
艰难梭菌（原称梭状芽孢杆菌）感染（CDI）是医疗保健相关腹泻的最常见病因，死亡率和复发率很高；此外，复发病例的治疗是一项挑战。在这项网络荟萃分析中，我们旨在比较所有可用疗法对多重复发性CDI（mrCDI）的疗效，并按疗效进行排名。
经过系统检索，纳入了针对mrCDI进行任何干预的随机对照试验（RCT）。使用Excel将数据提取到研究数据库中。使用Cochrane RoB 2工具进行偏倚风险评估。主要结局是CDI的临床治愈，次要结局是CDI的复发。采用贝叶斯方法研究疗法的疗效排名顺序。我们已在Prospero综述与传播中心注册了我们的方案（注册号CRD42020160365）。
定量综合分析纳入了六项RCT，共七种干预措施。根据累积排名曲线下面积值，短疗程万古霉素治疗后进行粪便微生物群移植（FMT）（83%）对临床治愈显示出最高疗效。托拉霉素和万古霉素+FMT在预防复发方面似乎最有效（分别为87%和75%）。
万古霉素+FMT可能是治疗和预防mrCDI最有效的选择，而托拉霉素在预防复发方面也有效。
