Goals: 

The aim was to assess the effectiveness of fecal microbiota transplantation (FMT) against medical therapy (MT).

Background: 

FMT has shown good outcomes in the treatment of Clostridium difficile infection (CDI). We aimed to conduct a systematic review and meta-analysis to compare the effectiveness of FMT versus MT for CDI.

Study: 

We performed a comprehensive search to identify randomized controlled trials comparing FMT against MT in patients with CDI. Outcomes of interest were clinical cure as determined by the resolution of diarrhea and/or negative C. difficile testing. Primary CDI is defined as the first episode of CDI confirmed endoscopically or by laboratory analysis. Recurrent C. difficile infection (RCDI) is defined as laboratory or endoscopically confirmed episode of CDI after at least 1 course of approved antibiotic regimen.

Results: 

A total of 7 studies with 238 patients were included in meta-analysis. Compared with MT, FMT did not have a statistically significant difference for clinical cure of combined primary and RCDI after first session [risk ratio (RR): 1.52, 95% confidence interval (CI): 0.90, 2.58; P=0.12; I²=77%] and multiple sessions of FMT (RR: 1.68; CI: 0.96, 2.94; P=0.07; I²=82%). On subgroup analysis, FMT has statistically higher rate of response than MT (RR: 2.41; CI: 1.20, 4.83; I²=78%) for RCDI. However, for primary CDI there is no statistically significant difference between FMT and MT (RR: 1.00; CI: 0.72, 1.39; I²=0%).

Conclusion: 

As per our analysis, FMT should not be utilized for every patient with CDI. It is more effective in RCDI, but the results were not significant in patients with primary CDI.

中文翻译：

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粪便微生物群移植和艰难梭菌感染的药物治疗：随机对照试验的荟萃分析

目标： 

目的是评估粪便微生物群移植（FMT）相对于药物治疗（MT）的有效性。

背景： 

FMT 在治疗艰难梭菌感染 (CDI) 方面显示出良好的效果。我们的目的是进行系统评价和荟萃分析，以比较 FMT 与 MT 对 CDI 的有效性。

学习： 

我们进行了全面检索，以确定在 CDI 患者中比较 FMT 与 MT 的随机对照试验。感兴趣的结果是根据腹泻缓解和/或艰难梭菌检测阴性确定的临床治愈。原发性 CDI 定义为经内窥镜或实验室分析证实的首次 CDI 发作。复发性艰难梭菌感染 (RCDI) 定义为经批准的抗生素治疗方案至少 1 个疗程后经实验室或内窥镜证实的 CDI 发作。

结果： 

荟萃分析共纳入 7 项研究，涉及 238 名患者。与MT相比，FMT首次治疗后原发性和RCDI联合临床治愈的临床治愈率没有统计学显着性差异[风险比（RR）：1.52，95%置信区间（CI）：0.90，2.58；P =0.12；I ² =77%]和多次 FMT（RR：1.68；CI：0.96，2.94；P =0.07；I ² =82%）。在亚组分析中，FMT 对 RCDI 的反应率在统计学上高于 MT（RR：2.41；CI：1.20，4.83；I ² = 78%）。然而，对于原发性 CDI，FMT 和 MT 之间没有统计学上的显着差异（RR：1.00；CI：0.72、1.39；I ² =0%）。

结论： 

根据我们的分析，FMT 不应用于每位 CDI 患者。它对 RCDI 更有效，但对原发性 CDI 患者效果不显着。