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Fecal microbiota transplantation for treatment of recurrent C. difficile infection: An updated randomized controlled trial meta-analysis
Open accessAbstract
OBJECTIVES: Although systematic evaluation has confirmed the efficacy of fresh fecal microbiota transplantation (FMT) for treatment of recurrent and/or refractory and/or relapse C. difficile infection (RCDI), it lacks the support of well-designed randomized controlled trials (RCTs), and the latest guidelines do not optimize the management of FMT. In this paper, we focus on an in-depth study of fresh FMT and fecal infusion times to guide clinical practice. METHODS: 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. The retrieval objects were published RCTs of RCDI treated by fresh FMT. The intervention group was fresh FMT group, while the control group included antibiotic therapy or placebo or frozen FMT or capsule. The primary and secondary outcomes were the clinical remission of diarrhea without relapse after 8-17 weeks and the occurrence of severe adverse events, respectively. Subgroup analysis analyzed the effect of single and multiple fecal infusions. Two authors independently completed the information extraction and assessed risk of bias and overall quality of the evidence. RESULTS: 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); the pooled relative risk (RR) was 0.38 (95%CI:0.16-0.87; I2 = 67%; P = 0.02) in the fresh FMT group, and the clinical heterogeneity was significant and random effects model was used; However, 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. Most mild to moderate adverse events caused by FMT were self-limited and could be quickly alleviated; no severe adverse events happened because of FMT. 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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“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 [4]
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“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 [4]
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Metadata
- Authors
- Hui, W., Li, T., Liu, W., Zhou, C., & Gao, F.
- Affiliations
- People's Hospital of Xinjiang Uygur Autonomous Region (CN)
- Nanchang University (CN)
- Corresponding author
- Gao, Feng
- Venue
- PLoS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2019-01-23
- Volume
- 14
- Issue
- 1
- Pages
- e0210016
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC6343888
- OpenAlex
- W2912755977
- Cited by
- 140
- References
- 60
- Citations by year
- 2026: 3 · 2025: 12 · 2024: 26 · 2023: 18 · 2022: 23 · 2021: 24 · 2020: 20 · 2019: 14
- FWCI
- 15.53
- Type
- journal article
- Language
- en
- Status
- Retracted
- Update notices
- retraction (2024-12-13)
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS ONE (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Figshare (submittedVersion, cc-by)
- 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, antibiotic therapy, adverse events, clinical remission, treatment efficacy comparison, risk of bias assessment, subgroup analysis, meta-analysis of RCTs, evidence quality grading
- MeSH terms
- Fecal Microbiota Transplantation, Anti-Bacterial Agents, Clostridium Infections, Diarrhea, Feces, Humans, Recurrence, Randomized Controlled Trials as Topic, Clostridioides difficile, Treatment Outcome
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