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Efficacy of different faecal microbiota transplantation protocols for Clostridium difficile infection: A systematic review and meta‐analysis
Open accessAbstract
Background Protocols for treating recurrent Clostridium difficile infection (rCDI) through faecal microbiota transplantation (FMT) are still not standardised. Our aim was to evaluate the efficacy of different FMT protocols for rCDI according to routes, number of infusions and infused material. Methods MEDLINE, Embase, SCOPUS, Web of Science and the Cochrane Library were searched through 31 May 2017. Studies offering multiple infusions if a single infusion failed to cure rCDI were included. Data were combined through a random effects meta‐analysis. Results Fifteen studies (1150 subjects) were analysed. Multiple infusions increased efficacy rates overall (76% versus 93%) and in each route of delivery (duodenal delivery: 73% with single infusion versus 81% with multiple infusions; capsule: 80% versus 92%; colonoscopy: 78% versus 98% and enema: 56% versus 92%). Duodenal delivery and colonoscopy were associated, respectively, with lower efficacy rates ( p = 0.039) and higher efficacy rates ( p = 0.006) overall. Faecal amount ≤ 50 g ( p = 0.006) and enema ( p = 0.019) were associated with lower efficacy rates after a single infusion. The use of fresh or frozen faeces did not influence outcomes. Conclusions Routes, number of infusions and faecal dosage may influence efficacy rates of FMT for rCDI. These findings could help to optimise FMT protocols in clinical practice.
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In the citing paper
“FMT was first investigated as a potential treatment for recurrent Clostridioides difficile infection (rCDI), where it has shown a consistent success rate of nearly 90% 3-5”
From Key determinants of success in fecal microbiota transplantation: From microbiome to clinic (2023) · cites this paper as [5]
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In the citing paper
“There is also evidence that also the amount of infused feces could influence the clinical effectiveness of FMT.”
From Key determinants of success in fecal microbiota transplantation: From microbiome to clinic (2023) · cites this paper as [5]
In the citing paper
“First, the transfer of a healthy intestinal microbiome, regardless of its composition, is consistently effective in rCDI, 3-5 so there was no need to refine donor screening for the only current clinical indication for FMT.”
From Key determinants of success in fecal microbiota transplantation: From microbiome to clinic (2023) · cites this paper as [5]
In the citing paper
“In a systematic review and meta-analysis of 15 studies and 1,150 subjects, a fecal amount % 50 g was associated with lower efficacy of single FMT at meta-regression analysis.”
From Key determinants of success in fecal microbiota transplantation: From microbiome to clinic (2023) · cites this paper as [5]
In the citing paper
“Although some metanalyses have assessed the efficacy of different routes, 3,5 a direct comparison has been provided only by few studies.”
From Key determinants of success in fecal microbiota transplantation: From microbiome to clinic (2023) · cites this paper as [5]
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Hays, R. A., & Surawicz, C. M. (2019) · Springer eBooks · doi:10.1007/978-3-319-90761-1_71-1
Faecal microbiota transplantation: a review
Sinclair, H., & Chapman, P. R. (2020) · Microbiology Australia · doi:10.1071/ma20019
Microbiota Based Management of the Gastrointestinal Disorders
Mouli, V. P., & Ahuja, V. (2020) · Elsevier eBooks · doi:10.1016/b978-0-12-819265-8.00011-5
Mehr Vorteile mit Eigen-Transplantat als mit Spendermikrobiota?
Adamek, H. E. (2021) · Info Diabetologie · doi:10.1007/s15034-021-3730-0
CLOSTRIDIUM DIFFICILE SUKELTAS ENTEROKOLITAS, VARTOJANT PROTONŲ SIURBLIO INHIBITORIUS
Juknevičiūtė, E., Banaitytė, D., & Dikčiūtė, A. (2022) · Health Sciences · doi:10.35988/sm-hs.2022.214
Fecal microbiota transplantation and ulcerative colitis remission: A meta-analysis
Mirghani, H. O., AlShalawi, A. A., Algabri, M. O., Albalawi, T. S., Albalawi, A. M. F., Albalawi, A. N. S., Alzamhari, O. S. A., Alshahrani, M. M. M., Albalawi, M. A. I., Alquthami, H. H. M., et al. (2022) · Medical Science · doi:10.54905/disssi/v26i130/ms570e2672
Ferre‐Aracil, C., Hajra, I. E., Mendoza, M. S. V., Ramos, A., Múñez, E., Fernández‐Cruz, A., Royo, V. M., García-Maseda, S., Romero, I. S., Martínez-Ruiz, R., et al. (2023) · Enfermedades infecciosas y microbiologia clinica (English ed ) · doi:10.1016/j.eimce.2022.01.004
Ortenberg, E. A. (2022) · Clinical Microbiology and Antimicrobial Chemotherapy · doi:10.36488/cmac.2022.4.308-313
Arbab, M. H. (2023) · Wiley eBooks · doi:10.1002/9781119904786.ch20
Fecal Microbiota Transplantation
Singh, B., Mal, G., Kalra, R. S., & Marotta, F. (2024) · Springer eBooks · doi:10.1007/978-3-031-65459-6_36
Безродна, О. В., & Kondratiuk, L. (2025) · Medical Science of Ukraine (MSU) · doi:10.32345/2664-4738.2.2025.18
Mytych, A., Groszewska, J., Romaniuk, M., Rapior, A., Makowska-Woszczyk, D., Lubomska, K., Jagura, P., Romaniuk, J., Dziedziak, M., & Nosek, Ł. (2025) · International Journal of Innovative Technologies in Social Science · doi:10.31435/ijitss.4(48).2025.4160
Lo, S.-W., Hung, T.-H., Lin, Y.-T., Lee, C.-S., Chen, C.-Y., Fang, C.-J., & Lai, P.-C. (2024) · Figshare · doi:10.6084/m9.figshare.27049199
Lo, S.-W., Hung, T.-H., Lin, Y.-T., Lee, C.-S., Chen, C.-Y., Fang, C.-J., & Lai, P.-C. (2024) · Figshare · doi:10.6084/m9.figshare.27049190
Lo, S.-W., Hung, T.-H., Lin, Y.-T., Lee, C.-S., Chen, C.-Y., Fang, C.-J., & Lai, P.-C. (2024) · Figshare · doi:10.6084/m9.figshare.27049205
Lo, S.-W., Hung, T.-H., Lin, Y.-T., Lee, C.-S., Chen, C.-Y., Fang, C.-J., & Lai, P.-C. (2024) · Figshare · doi:10.6084/m9.figshare.27049196
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Methodological insights into fecal microbiota transplantation: Dissecting key approaches for success
Mundhra, S. K., & Kochhar, R. (2026) · World Journal of Methodology · doi:10.5662/wjm.v16.i1.108875 · Cited by 1
Microbial Natural Products: A Source of Novel Antibiotics and Immunomodulators
REHMAN, A., NASEEM, F., ANWAR, A., AHMAD, H., Qadir, D., Majid, M. S., & Salar, M. Z. (2025) · doi:10.61748/npbr.2025/14
Neurobiological effects of microbial treatments within psychiatry: a systematic review
Sgarbossa, C., Forth, E., Squires, S. D., Groth, A., Farid, M., Gallant, K., Desai, D., Redfearn, W., & Milev, R. V. (2026) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2026.1745964
Metadata
- Authors
- Ianiro, G., Maida, M., Burisch, J., Simonelli, C., Hold, G., Ventimiglia, M., Gasbarrini, A., & Cammarota, G.
- Affiliations
- Università Cattolica del Sacro Cuore (IT)
- Section of Gastroenterology S. Elia - Raimondi Hospital Caltanissetta Italy
- Zealand University Hospital (DK)
- UNSW Sydney (AU)
- Ospedale Vincenzo Cervello (IT)
- Corresponding author
- Ianiro, Gianluca
- ORCID
- Venue
- United European Gastroenterology Journal
- Publisher
- Wiley
- Published
- 2018-10
- Volume
- 6
- Issue
- 8
- Pages
- 1232-1244
- ISSN
- 2050-6406 (ISSN-L)
- 2050-6414
- PMC
- PMC6169051
- OpenAlex
- W2807489422
- Semantic Scholar
- e6ac43617453aaa7fa983df0179c26b085f1375d
- Cited by
- 203
- References
- 36
- Citations by year
- 2026: 13 · 2025: 25 · 2024: 28 · 2023: 20 · 2022: 23 · 2021: 29 · 2020: 38 · 2019: 25 · 2018: 2
- FWCI
- 3.45
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- United European Gastroenterology Journal (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- PubliCatt (Università Cattolica del Sacro Cuore) (submittedVersion, other-oa)
- Topics
- Health Sciences › Medicine › Infectious Diseases › Clostridium difficile and Clostridium perfringens research
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Gut microbiota and health
- Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
- Keywords
- fecal microbiota transplantation, recurrent Clostridium difficile infection, delivery routes, colonoscopy, enema, treatment efficacy
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