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Fecal microbiota transplantation shows promise as C. difficile therapy
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Fecal microbiota transplantation may be an effective method of treating Clostridium difficile infection, but additional study is necessary for confirmation, according to a recent review.
Researchers performed a systematic review and meta-analysis of 11 studies involving 273 patients with C. difficile infection treated via fecal microbiota transplantation (FMT). Clinical resolution was observed, with unweighted (UPR) and weighted pooled resolution rates (WPR) calculated across the studies and in subgroup analysis. Study quality was assessed via NICE criteria, with seven studies scoring 4 or higher and four scoring below 4. No studies received a maximum score (8), indicating a “high-quality” study.
Clinical resolution occurred in 245 patients (UPR=89.7%; WPR=89.1%), with no significant heterogeneity observed (P=.13; I2=33.7%). Further analysis using the researchers’ definition of clinical resolution, excluding three cases that received FMT without a positive result for infection, yielded similar results (UPR=91.1%; WPR=90.9%) without heterogeneity (P=.07; I2=41.9%).
Subgroup analysis comparing anonymous donors (three studies) with those selected by patients (nine studies) indicated no difference in outcome (UPR=89.5% vs. 90.7%; WPR=89.2% vs. 89.9%). Lower GI FMT delivery, in eight studies, trended toward higher resolution than upper GI delivery, assessed in five studies (UPR=91.4% vs. 82.3%; WPR=91.2% vs. 80.6%; P=.046 for UPR and P>.05 for WPR). Investigators said resolution rates were greater among higher-quality studies (UPR=93.5% vs. 81.8%; WPR=92.9% vs. 80.6% for studies with NICE scores of 4 or higher vs. below 4; P=.003 for UPR and P<.05 for WPR).
Zain Kassam
“Our meta-analysis confirms that FMT holds considerable promise for recurrent C. difficile infection based on a summary of the best available evidence,” Zain Kassam, MD, FRCPC, chief gastroenterology resident at McMaster University, told Healio.com, adding that caution should be exercised. “Before widely advocating FMT, many questions must still be answered, including what is the ideal protocol, who is the right patient, and what donor is most suitable.
“Quantifying the known infectious risks and systematically reporting the unknown risks of FMT, given the microbiome implications in diseases ranging from anxiety to IBD, must be done to continue to advance this field.”
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