An effective solution for recurrent C. difficile infections

In a recent study published in Cochrane database of systematic reviews, Researchers provide an overview of fecal microbiota transplantation (FMT) in treating relapse Clostridioides difficile Infection (rCDI).

study: Fecal Microbiota Transplant for Treatment of Recurrent Clostridioides difficile (Clostridium difficile)Image Credit: Prrrettty / Shutterstock.com

Treatment of CDI

it’s difficult, is a bacterial organism that can repeatedly cause potentially fatal diarrhea when an individual is infected with a microbial symbiosis. Conventional approaches to treat CDI include antibiotics, which can further exacerbate changes in the gut microbiome.

FMT can also be used to manage CDI by restoring balance in the gut microbiota. Nonetheless, further studies, including randomized controlled trials (RCTs), are needed to assess the risk-benefit ratio of FMT on rCDI management.

About research

In the current systematic review, researchers review existing data on FMT as a management option for rCDI compared to conventional therapeutic approaches including antibiotics.

The team used standard and extensive Cochrane methods to search for relevant data through March 31, 2022. Only RCTs that included pediatric and/or adult rCDI patients provided interventions that met the FMT criteria. The gastrointestinal (GI) tract of rCDI patients was included.

Other treatment groups included those who received placebo therapy, no therapeutic intervention, autologous FMT, or antibiotics to treat CDI.

The primary study outcomes were cDI recovery and the proportion of individuals with serious adverse events. Secondary study outcomes included treatment failure, all-cause mortality, withdrawal from the study, recurrence rate of CDI infection after FMT, adverse events, quality of life, and colectomy rate.

The quality of the evidence was assessed using the Evaluation of Recommendations, Evaluation, Development and Evaluation (GRADE) approach. We assessed the risk of bias of the included studies using the Risk of Bias 2 (RoB 2) tool. In addition, the risk ratio (RR) and number needed to treat additional beneficial outcome (NNTB) were calculated.

result

A total of 6 RCTs involving 320 adults were considered in the final review. These trials were conducted in several countries including Italy, Denmark, Netherlands, USA and Canada.

Four RCTs were conducted in one center, whereas two RCTs were conducted in multiple centres. Only one RCT included immunocompromised patients evenly distributed between intervention (FMT) and control (non-FMT) groups.

One RCT administered FMT through the upper gastrointestinal tract using a nasoduodenal tube. In comparison, 2 RCTs involved enema administration of FMT and 2 other RCTs involved colonoscopy administration of FMT. In one RCT involving colonoscopy or nasojejunal delivery of donor feces, dosing choice was based on individual colonoscopy tolerance.

Five recordings included one or more comparison groups receiving vancomycin. There was no high risk of bias for any of the study results.

safety and effectiveness of FMT in the treatment of rCDI was evaluated in all included RCTs. Pooled data from all studies indicated that FMT likely enhanced her rCDI resolution in immunocompetent individuals compared with controls.

The RR and NNTB values ​​were 1.9 and 3.0, respectively. The included studies were considered to be of moderate quality.

Importantly, FMT led to a modest reduction in serious adverse events. However, these observations were associated with wide confidence interval (CI) estimates, including RR and NNTB values ​​of 0.7 and 12, respectively, thus indicating moderate certainty of this evidence.

All-cause mortality, assessed from only a small number of events, decreased after FMT, with RR and NNTB values ​​of 0.6 and 20, respectively. The certainty of the evidence for this finding was low.

Colectomy rates were not described in any of the RCTs. Similar results were obtained when RCTs involving immunosuppressed individuals were excluded.

Conclusion

Based on these findings, FMT is more likely than alternative therapies, including antibiotics, to resolve rCDI in immunocompetent adults with rCDI. Only a few adverse events and deaths from any cause were reported. Therefore, no conclusive evidence regarding the safety of FMT was obtained.

Further studies, including analysis of data recorded in large and national registries, are needed to assess the acute and chronic risks associated with FMT administration in patients with rCDI. Future studies should assess the therapeutic efficacy of FMT in immunosuppressed individuals to devise health policies and strategies accordingly, prioritizing those individuals most likely to benefit from treatment.