Systematic review with meta-analysis: long-term outcomes of faecal microbiota transplantation forClostridium difficileinfection

Abstract

Summary Background Clostridium difficile infection is a major cause of nosocomial diarrhoea. Aim To evaluate long‐term (≥90 days) efficacy and safety of faecal microbiota transplantation for C. difficile infection and explore the factors affecting the faecal microbiota transplantation outcomes. Methods MEDLINE, the Cochrane Library and EMBASE were searched and only observational studies that utilised faecal microbiota transplantation for C. difficile infection with long‐term follow‐up duration (≥90 days) were included. Primary cure rate, overall recurrence rate and early (<90 days) and late (≥90 days) recurrence rate were calculated. Results Eighteen observational studies with 611 patients were included. The primary cure rate was 91.2% (95% confidence interval, CI 86.7–94.8%). The overall recurrence rate was 5.5% (95% CI 2.2–10.3%). The early recurrence rate and late recurrence rate were 2.7% (95% CI 0.7–6.0%) and 1.7% (95% CI 0.4–4.2%) respectively. Most adverse events were expected, short‐lived, self‐limited and manageable. The association between faecal microbiota transplantation therapy and adverse events such as inflammatory bowel disease flare, infectious disease and autoimmune disease was a concern but remained insignificant. Old age (≥65 years) was identified as a risk factor for after faecal microbiota transplantation therapy. Upper gastrointestinal administration also results in less frequent primary cure. Conclusions Faecal microbiota transplantation seems to be a highly effective and robust therapy for recurrent C. difficile infection. However, more quality studies, such as randomised controlled trials and cohort studies with control groups, are needed to confirm its long‐term efficacy and safety.

Successful Therapy of Clostridium Difficile Infection with Fecal Microbiota Transplantation

“…The cure rate in our FMT-treated patients was 94%. Our data are conform to the results obtained in previous studies (12). In one patient with severe, pseudomembranous, therapyrefractory CDI the application of FMT failed.…”

“…The first very promising, placebo-controlled trial by Van Nood et al, confirmed the high effectivity of this method in the treatment of CDI (11). Further meta-analyses demonstrated a cure rate of over 90% in CDI patients treated with FMT (12). The effectiveness of FMT in patients with CDI provides important proof of concept that dysbiotic gut microbiota can be restored by transplantation of microbiota from a healthy donor.…”

Nutrition and the gut microbiome in the elderly

“…In spite of this, a recent systematic and meta-analysis indicates that adverse events after fecal microbiota transplantation such as autoimmune disease and infectious disease was not significant in a follow up of 90 d after transplantation, whereas authors identified old age of patients (>65 years) as a risk factor for the primary cure failure and early recurrence. 46 Beyond this, it should be possible to isolate a fecal cocktail of defined bacterial multi-species and/or design synthetic mixtures that could be administered for correcting intestinal dysbiosis, thus avoiding the risk of transmission of potentially harmful microorganisms from donors to recipients. 47 …”

The role of inflammation in temporal shifts in the inflammatory bowel disease mucosal microbiome

“…Our group has previously demonstrated that bowel preparation and colonoscopy does not change the microbiota in most subjects, 30 but noted that three patients suffering from ulcerative colitis did not have restoration of their pre-colonoscopy microbiome. Therapeutic manipulation of the microbiome, for example with faecal microbial transplantation, has had mixed results in IBD cohorts compared to those with recurrent Clostridium difficile colitis, 31 , 32 also raising the possibility that there is instability of the microbiome in IBD patients compared to previously healthy subjects.…”