Abstract
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.
| Original language | English |
|---|---|
| Pages (from-to) | 1232-1244 |
| Number of pages | 13 |
| Journal | United European Gastroenterology Journal |
| Volume | 6 |
| Issue number | 8 |
| DOIs | |
| Publication status | Published - Oct 1 2018 |
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Keywords
- Clostridium difficile
- faecal microbiota transplantation
- faecal transplant
- meta-analysis
- systematic review
ASJC Scopus subject areas
- Oncology
- Gastroenterology
Cite this
Efficacy of different faecal microbiota transplantation protocols for Clostridium difficile infection : A systematic review and meta-analysis. / Ianiro, Gianluca; Maida, Marcello; Burisch, Johan; Simonelli, Claudia; Hold, Georgina; Ventimiglia, Marco; Gasbarrini, Antonio; Cammarota, Giovanni.
In: United European Gastroenterology Journal, Vol. 6, No. 8, 01.10.2018, p. 1232-1244.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Efficacy of different faecal microbiota transplantation protocols for Clostridium difficile infection
T2 - A systematic review and meta-analysis
AU - Ianiro, Gianluca
AU - Maida, Marcello
AU - Burisch, Johan
AU - Simonelli, Claudia
AU - Hold, Georgina
AU - Ventimiglia, Marco
AU - Gasbarrini, Antonio
AU - Cammarota, Giovanni
PY - 2018/10/1
Y1 - 2018/10/1
N2 - 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.
AB - 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.
KW - Clostridium difficile
KW - faecal microbiota transplantation
KW - faecal transplant
KW - meta-analysis
KW - systematic review
UR - http://www.scopus.com/inward/record.url?scp=85048032296&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85048032296&partnerID=8YFLogxK
U2 - 10.1177/2050640618780762
DO - 10.1177/2050640618780762
M3 - Article
VL - 6
SP - 1232
EP - 1244
JO - United European Gastroenterology Journal
JF - United European Gastroenterology Journal
SN - 2050-6406
IS - 8
ER -