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Fecal microbiota transplantation for treatment of recurrent C. difficile infection: An updated randomized controlled trial meta-analysis.

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PubMed ID: 30673716

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Hui W, Li T, Liu W, Zhou C, Gao F

PLoS One. 2019. doi: 10.1371/journal.pone.0210016

COMMENT: In this article the authors reviewed recent articles about controlled clinical trials using fecal microbiota transplantation (FMT) for treatment of Clostridioides difficile (formerly called Clostridium difficile) recurrent and/or refractory and/or relapse infection (RCDI). The objective of this study is to guide clinical practice in the management of these treatments based on fresh FMT.

MAIN RESULTS:

We reviewed studies in PubMed, Medline, Embase, the Cochrane library and Cochrane Central written in English. The retrieval period was from the establishment of the databases to September 20th, 2018.

8 randomized controlled trials met the inclusion criteria, involving 537 patients (273 in the fresh FMT group and 264 in the control group).

The recurrence rate of clinical diarrhea in the fresh FMT group was 11.0% (30/273), which was significantly lower than the control group (24.6%, 65/264; P < 0.05). 

... there was no significant difference neither for the effect of antibiotic treatment/frozen feces transplanted by enema (RR = 1.07; 95%CI: 0.64–1.80; I2 = 0%; P = 0.79) or capsule/frozen feces transplanted by colonoscopy (RR =0.42; 95%CI: 0.05–3.94; I2 = 43%; P=0.45) compared with fresh FMT. The subgroup analysis showed that FMT by multiple infusions could effectively and significantly (RR = 0.24; 95%CI:0.10–0.58; I2 = 0%; P = 0.001) improve the clinical diarrhea remission rate.

CONCLUSIONS:

Overall, the use of fresh feces for bacterial transplantation was the best efficiency for RCDI compared to antibiotic therapy or placebo. The fecal transmission method by enema was not ideal, but capsules or frozen feces transported by colonoscopy could be an alternative treatment compared to fresh FMT. For patients with severe RCDI, multiple fecal transplants can effectively improve their diarrhea remission rate. The focus of future research should be on how to standardize the production of capsules or frozen feces to better guide the clinical management of RCDI patients by FMT.

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Raquel Tobes