Rapoport Eliot A, Baig Muhammad, Puli Srinivas R
Department of Gastroenterology and Hepatology, University of Illinois College of Medicine at Peoria, Peoria, IL, USA (Eliot A. Rapoport, Muhammad Baig, Srinivas R. Puli).
Ann Gastroenterol. 2022 Mar-Apr;35(2):150-163. doi: 10.20524/aog.2022.0695. Epub 2022 Feb 14.
Fecal microbiota transplantation (FMT) is a highly efficacious procedure used most commonly for the treatment of recurrent Clostridioides difficile infection (CDI). Despite the high value of incorporating FMT into practice, there remain concerns about its safety. To the best of our knowledge, there has not been an updated meta-analysis reporting pooled rates of adverse events in FMT for CDI.
A search for studies of FMT in patients with CDI was performed with the rate of serious adverse events (SAEs) related to FMT evaluated as the primary outcome. Secondary outcomes included SAEs unrelated to FMT and minor adverse events associated with FMT. A pooled analysis was then performed.
Initial search identified 378 reference articles. Data were extracted from the 61 of these studies that met the inclusion criteria, comprising 5099 patients. Pooled analysis showed that SAEs related to FMT developed in less than 1% of patients. The pooled rate of SAEs not related to FMT was higher at 2.9%. The pooled rate of minor adverse events also showed infrequent self-limited gastrointestinal and systemic discomfort.
This meta-analysis supports FMT as a safe option for treating recurrent CDI. Future randomized trials are needed to improve our current understanding of FMT safety and further examine the improvements in the quality of life of patients treated with FMT compared to standard therapy of antibiotics.
粪便微生物群移植（FMT）是一种高度有效的治疗方法，最常用于治疗复发性艰难梭菌感染（CDI）。尽管将FMT纳入临床实践具有很高的价值，但人们仍对其安全性存在担忧。据我们所知，尚未有更新的荟萃分析报告CDI患者接受FMT后不良事件的汇总发生率。
检索了关于CDI患者FMT的研究，将与FMT相关的严重不良事件（SAE）发生率作为主要结局进行评估。次要结局包括与FMT无关的SAE和与FMT相关的轻微不良事件。然后进行汇总分析。
初步检索确定了378篇参考文献。从符合纳入标准的61项研究中提取数据，共纳入5099例患者。汇总分析显示，接受FMT的患者中发生与FMT相关SAE的比例不到1%。与FMT无关的SAE汇总发生率较高，为2.9%。轻微不良事件的汇总发生率也显示为偶发的自限性胃肠道和全身不适。
这项荟萃分析支持FMT作为治疗复发性CDI的安全选择。未来需要进行随机试验，以增进我们目前对FMT安全性的理解，并进一步研究与抗生素标准治疗相比，接受FMT治疗的患者生活质量的改善情况。
