Fecal Microbiota Transplantation for Severe or Fulminant Clostridioides difficile Infection: Systematic Review and Meta-analysis.
Level 4 - case-series / case-control
Systematic review composed predominantly of case series (8 of 10 included studies)
PubMed 35118227 · doi:10.1093/jcag/gwab023
What was done
A systematic review and meta-analysis searched PubMed, Web of Science, EMBASE, and Cochrane databases from inception through 2020 for studies evaluating fecal microbiota transplantation (FMT) in medically refractory severe or fulminant Clostridioides difficile infection (SFCDI). Quality was assessed using NIH Study Quality Assessment tools. The primary outcome was resolution of SFCDI 4 weeks after the final FMT, pooled via generalized linear mixed models.
What was found
Ten studies encompassing 240 patients (8 case series, 1 case-control, 1 randomized study; 209 with individual patient data) were analyzed. Resolution occurred in 211 of 240 patients, for a pooled resolution rate of 88% (95% CI: 0.83 to 0.91). Mean number of FMT procedures required was 1.6 for severe and 2.0 for fulminant CDI. Post-FMT CDI-directed antimicrobials were required in a pooled estimate of 50% (95% CI: 0.06 to 0.94) of severe cases and 67.0% (95% CI: 0.30 to 0.91) of fulminant cases. Serious adverse event rates were low.
Why it matters
FMT demonstrates high pooled efficacy in severe and fulminant CDI where medical management has failed, but clinicians must expect the frequent necessity of repeated instillations and ongoing antimicrobial therapy.
Limits
The evidence base is dominated by small, retrospective case series with high potential for selection and reporting biases. Estimates for subsequent antibiotic requirements were highly imprecise with very wide confidence intervals, and optimal delivery routes remain undefined.
Cited by
- supports Fecal microbiota transplants are used successfully to treat and prevent death from Clostridium difficile (C. diff) infections.