Liu Yanghua, Alnababtah Kal, Cook Simon, Yu Ying
Department of Nursing, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China.
Faculty of Health, Education and Life Sciences, Birmingham City University, Birmingham, UK.
Therap Adv Gastroenterol. 2021 Sep 20;14:17562848211042679. doi: 10.1177/17562848211042679. eCollection 2021.
Clostridioides difficile infection (CDI) and inflammatory bowel disease (IBD) are global gastroenterological diseases that cause considerable burden on human health, healthcare systems, and society. Faecal microbiota transplantation (FMT) is an effective treatment for recurrent Clostridioides Difficile Infection (rCDI) and a promising therapy for IBD. However, indication for FMT in IBD is still unofficial. Consequently, the National Institute for Health and Care Excellence (NICE) is seeking healthcare providers' advice on whether to update FMT guidelines.
A systematic review methodology was adopted for this study. Five databases (CINAHL, MEDLINE, Cochrane Library, Scopus, Web of Science) and grey literature were systematically searched for English language literature to 14 May 2021. The quality of the included studies was then appraised using the Institute for Public Health Sciences cross-sectional studies tool, after which the findings of the studies were narratively synthesised.
Thirteen cross-sectional studies with 4110 validated questionnaire responses were included. Narrative synthesis found that 39.43% of respondents were familiar with FMT (N = 3746, 95%CI = 37.87%-41%), 58.81% of respondents would recommend FMT to their patients (N = 1141, 95%CI = 55.95%-61.67%), 66.67% of respondents considered lack of clinical evidence was the greatest concern regarding FMT (N = 1941, 95%CI = 64.57%-68.77%), and 40.43% respondents would not implement FMT due to concerns about infection transmission (N = 1128, 95%CI = 37.57%-43.29%).
Healthcare providers' knowledge of FMT is relatively low and education is an effective strategy to improve it. As knowledge of FMT increases, willingness to recommend it also increases. Strengthening FMT clinical efficacy and reducing infection can enhance its public acceptance, application and popularity. However, further research is required to explore the donor screening procedure.
艰难梭菌感染（CDI）和炎症性肠病（IBD）是全球性的胃肠疾病，给人类健康、医疗系统和社会带来了相当大的负担。粪便微生物群移植（FMT）是复发性艰难梭菌感染（rCDI）的有效治疗方法，也是IBD的一种有前景的治疗方法。然而，IBD中FMT的适应证仍未得到官方认可。因此，英国国家卫生与临床优化研究所（NICE）正在就是否更新FMT指南征求医疗服务提供者的意见。
本研究采用系统评价方法。系统检索了五个数据库（CINAHL、MEDLINE、Cochrane图书馆、Scopus、科学网）以及灰色文献，以查找截至2021年5月14日的英文文献。然后使用公共卫生科学研究所的横断面研究工具对纳入研究的质量进行评估，之后对研究结果进行叙述性综合分析。
纳入了13项横断面研究，共获得4110份有效问卷回复。叙述性综合分析发现，39.43%的受访者熟悉FMT（N = 3746，95%CI = 37.87%-41%），58.81%的受访者会向其患者推荐FMT（N = 1141，95%CI = 55.95%-61.67%），66.67%的受访者认为缺乏临床证据是对FMT最主要的担忧（N = 1941，95%CI = 64.57%-68.77%），40.43%的受访者因担心感染传播而不会实施FMT（N = 1128，95%CI = 37.57%-43.29%）。
医疗服务提供者对FMT的了解程度相对较低，教育是提高这种了解的有效策略。随着对FMT了解的增加，推荐它的意愿也会增加。加强FMT的临床疗效并减少感染可以提高其公众接受度、应用率和普及程度。然而，需要进一步研究来探索供体筛查程序。
