Efficacy and safety of fecal microbiota transplantation in clostridium difficile infection: an overview of systematic reviews_Chinese Journal of Evidence-Based Medicine

Authors：

MENG Min ^1,2 , LIU Kai ³ , YANG Xue ⁴ , ZAN Junmin ⁵ ,  GUO Yinyin ² ,  GE Bin ¹

1. Parmarcy Department, Gansu Provincial Hosptial, Lanzhou, 730000, P.R.China;
2. Parmarcy Department, The Second Hospital of Lanzhou University, Lanzhou, 730000, P.R.China;
3. Parmarcy Department, The Fourth Hospital Affiliated Zhejiang University, Yiwu, 322000, P.R.China;
4. Parmarcy Department, Qingyang People’s Hospital, Qingyang, 745000, P.R.China;
5. Parmarcy Department, Dingxi People’s Hospital, Dingxi, 743000, P.R.China;

Corresponding author：

GUO Yinyin, Email: 782733485@qq.com; GE Bin, Email: gjy0630@163.com

Keywords：

Fecal microbiota transplantation; Clostridium difficile infection; Pseudomembranous colitis; Systematic review; Overview

DOI：

10.7507/1672-2531.201608022

Video：

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Objective To overview the systematic review(SR) of efficacy and safety of fecal microbiota transplantation (FMT) in clostridium difficile infection (CDI). Methods PubMed, The Cochrane Library, EMbase, CNKI, VIP, WanFang Data databases and related website (http://scholar.google.com/) were electronically searched to collect SR and meta-analysis on FMT of CDI. The quality of collected documents and evidences were evaluated by OQAQ (Overview Quality Assessment Questionnaire) and GRADE (Grading of Recommendations Assessment, Development and Evaluation), respectively. Results Eleven SRs were included, in which 4 were completed by meta-analysis. The results of OQAQ showed that the score of one review was 2, the others SR received scores from 5 to 9. There were 9 SRs had reported the CDI clinical resolution rate (CRR), of which one SR showed CRR was 36.2%, and the others showed CRR were about 90%. Compared to upper gastrointestinal FMT, all studies showed lower gastrointestinal FMT (colonoscopy, enemas, etc.) had a higher CRR. The outcomes of selection and random fecal donor had no significant differences, and authors suggested that there should be made a standardization of donor screening table for safe fecal. Present evidence showed FMT were safety, and the majority of adverse events of FMT appeared to be mild, self-limiting and gastrointestinal in nature. The GRADE quality level of SR indicated from very low to moderate. Conclusion FMT, as a treatment for CDI, shows significant efficacy and safety, but need more high-level evidences because of its clinical translation difficulties. The study also give a reference to develop standardized clinical pathways of FMT to policy researchers.

Citation： MENG Min, LIU Kai, YANG Xue, ZAN Junmin, GUO Yinyin, GE Bin. Efficacy and safety of fecal microbiota transplantation in clostridium difficile infection: an overview of systematic reviews. Chinese Journal of Evidence-Based Medicine, 2017, 17(11): 1318-1324. doi: 10.7507/1672-2531.201608022 Copy

1.	Bartleet JG. Antibiotic-associated diarrhea. N Engl J Med, 2002, 346(5): 334-339.
2.	宋征, 郑翠翠, 苟春霞, 等. 临床药师对抗生素相关性腹泻治疗的药学干预要点. 药学研究, 2015, 34(11): 673-675.
3.	Bauer MP, Dissel JT. Alternative strategies for Clostridium difficile infection. Int J Antimicrob Agents, 2009, 33(Suppl 1): S51-56.
4.	Surwicz CM, Brandt LJ, Binion DG, et al. Guidelines for diagnosis, treatment, and prevention of clostridium difficile infections. Am J Gastroenterology, 2013, 108(4): 478-598.
5.	Zhang F, Luo W, Shi Y, et al. Should we standardize the 1700-year-old fecal microbiota transplantation? Am J Gastroenterology, 2012, 107(11): 1755-1756.
6.	Eiseman B, Silen W, Bascom GS, et al. Fecal enema as an adjunct in the treatment of pseudomembranous enterocolitis. Surgery, 1958, 44(5): 854-859.
7.	Borody TJ, Khoruts A. Fecal microbiota transplantation and emerging applications. Nat Rev Gastroenterol Hepatol, 2011, 9(2): 88-96.
8.	Bakken JS. Fecal bacteriotherapy for recurrent Clostridium difficile infection. Anaerobe, 2009, 15(6): 285-289.
9.	Gough E, Shaikh H, Manges AR. Systematic review of intestinal microbiota transplantation for recurrent Clostridium difficile infection. Clin Infect Dis, 2011, 53(10): 994-1002.
10.	Guo B, Harstall C, Loute T, et al. Systematic review: faecal transplantation for the treatment of Clostridium difficile-associated disease. Aliment Pharmacol Ther, 2012, 35(8): 865-875.
11.	Nooda EV, Speelmana P, Nieuwdorp M. Fecal microbiota transplantation: facts and controversies. Curr Opin Gastroenterol, 2014, 30(1): 1267-1379.
12.	Oxman AD, Guyatt GH. Validation of an index of the quality of review articles. J Clin Epidemiol, 1991, 44(11): 1271-1278.
13.	Guyatt GH, Oxman AD, Vist GE, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ, 2008, 336(7650): 924-926.
14.	Sofi AA, Silverman AL, Khuder S, et al. Relationship of symptom duration and fecal bacteriotherapy in Clostridium difficile infectionpooled data analysis and a systematic review. Scandin J Gastro, 2013, 48(3): 266-273.
15.	Kassam Z, Lee CH, Yuan YH, et al. Fecal microbiota transplantation for clostridium difficile infection: systematic review and meta-analysis. Am J Gastroenterol, 2013, 108(8): 500-508.
16.	Colman RJ, Rubin DT. Fecal microbiota transplantation as therapy for inflammatory bowel disease: A systematic review and meta-analysis. J Crohn's Colitis, 2014, 8(12): 1569-1581.
17.	Sha S, Liang J, Chen M, et al. Systematic review: faecal microbiota transplantation therapy for digestive and nondigestive disorders in adults and children. Aliment Pharmacol Ther, 2014, 39(10):1003-1032.
18.	Dodin M, Katz DE. Faecal microbiota transplantation for clostridium difficile infection. Int J Clin Pract, 2014, 68(3): 363-368.
19.	Rossen NG, Macdonald JK, Devries EM, et al. Fecal microbiota transplantation as novel therapy in gastroenterology: A systematic review. World J Gastroenterol, 2015, 21(17): 5359-5371.
20.	Li YT, Cai HF, Wang ZH, et al. Systematic review with meta-analysis: long-term outcomes of faecal microbiota transplantation for clostridium difficile infection. Aliment Pharmacol Ther, 2016, 43(4): 445-457.
21.	郑晗晗, 江学良. 粪便菌群移植治疗艰难梭菌感染有效性和安全性的 Meta 分析. 中国全科医学, 2016, 19(2): 199-205.
22.	Baxter M, Colville A. Adverse events in faecal microbiota transplant: a review of the literature. J H Infec, 2016, 92(2): 117-127.
23.	Mathur H, Rea MC, Paul D, et al. The potential for emerging therapeutic options for clostridium difficile infection. Gut Microbes, 2015, 6(5): 696-710.

1. Bartleet JG. Antibiotic-associated diarrhea. N Engl J Med, 2002, 346(5): 334-339.
2. 宋征, 郑翠翠, 苟春霞, 等. 临床药师对抗生素相关性腹泻治疗的药学干预要点. 药学研究, 2015, 34(11): 673-675.
3. Bauer MP, Dissel JT. Alternative strategies for Clostridium difficile infection. Int J Antimicrob Agents, 2009, 33(Suppl 1): S51-56.
4. Surwicz CM, Brandt LJ, Binion DG, et al. Guidelines for diagnosis, treatment, and prevention of clostridium difficile infections. Am J Gastroenterology, 2013, 108(4): 478-598.
5. Zhang F, Luo W, Shi Y, et al. Should we standardize the 1700-year-old fecal microbiota transplantation? Am J Gastroenterology, 2012, 107(11): 1755-1756.
6. Eiseman B, Silen W, Bascom GS, et al. Fecal enema as an adjunct in the treatment of pseudomembranous enterocolitis. Surgery, 1958, 44(5): 854-859.
7. Borody TJ, Khoruts A. Fecal microbiota transplantation and emerging applications. Nat Rev Gastroenterol Hepatol, 2011, 9(2): 88-96.
8. Bakken JS. Fecal bacteriotherapy for recurrent Clostridium difficile infection. Anaerobe, 2009, 15(6): 285-289.
9. Gough E, Shaikh H, Manges AR. Systematic review of intestinal microbiota transplantation for recurrent Clostridium difficile infection. Clin Infect Dis, 2011, 53(10): 994-1002.
10. Guo B, Harstall C, Loute T, et al. Systematic review: faecal transplantation for the treatment of Clostridium difficile-associated disease. Aliment Pharmacol Ther, 2012, 35(8): 865-875.
11. Nooda EV, Speelmana P, Nieuwdorp M. Fecal microbiota transplantation: facts and controversies. Curr Opin Gastroenterol, 2014, 30(1): 1267-1379.
12. Oxman AD, Guyatt GH. Validation of an index of the quality of review articles. J Clin Epidemiol, 1991, 44(11): 1271-1278.
13. Guyatt GH, Oxman AD, Vist GE, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ, 2008, 336(7650): 924-926.
14. Sofi AA, Silverman AL, Khuder S, et al. Relationship of symptom duration and fecal bacteriotherapy in Clostridium difficile infectionpooled data analysis and a systematic review. Scandin J Gastro, 2013, 48(3): 266-273.
15. Kassam Z, Lee CH, Yuan YH, et al. Fecal microbiota transplantation for clostridium difficile infection: systematic review and meta-analysis. Am J Gastroenterol, 2013, 108(8): 500-508.
16. Colman RJ, Rubin DT. Fecal microbiota transplantation as therapy for inflammatory bowel disease: A systematic review and meta-analysis. J Crohn's Colitis, 2014, 8(12): 1569-1581.
17. Sha S, Liang J, Chen M, et al. Systematic review: faecal microbiota transplantation therapy for digestive and nondigestive disorders in adults and children. Aliment Pharmacol Ther, 2014, 39(10):1003-1032.
18. Dodin M, Katz DE. Faecal microbiota transplantation for clostridium difficile infection. Int J Clin Pract, 2014, 68(3): 363-368.
19. Rossen NG, Macdonald JK, Devries EM, et al. Fecal microbiota transplantation as novel therapy in gastroenterology: A systematic review. World J Gastroenterol, 2015, 21(17): 5359-5371.
20. Li YT, Cai HF, Wang ZH, et al. Systematic review with meta-analysis: long-term outcomes of faecal microbiota transplantation for clostridium difficile infection. Aliment Pharmacol Ther, 2016, 43(4): 445-457.
21. 郑晗晗, 江学良. 粪便菌群移植治疗艰难梭菌感染有效性和安全性的 Meta 分析. 中国全科医学, 2016, 19(2): 199-205.
22. Baxter M, Colville A. Adverse events in faecal microbiota transplant: a review of the literature. J H Infec, 2016, 92(2): 117-127.
23. Mathur H, Rea MC, Paul D, et al. The potential for emerging therapeutic options for clostridium difficile infection. Gut Microbes, 2015, 6(5): 696-710.

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