Fecal Microbiota Transplantation For Treatment Of Recurrent Clostridioides Difficile Infection:a Network Meta-analysis

Objective:Clostridioides difficile is a major reason of nosocomial infection-associated diarrhea and antibiotic-associated diarrhea.CDI is characterized by high recurrence after antibiotic treatment.RCDI increases patients’ risk of complications,hospitalization,and death.Fecal bacteria transplantation is considered to be an effective treatment for RCDI.This is of great significance for alleviating the pain of patients and reducing the burden of medical treatment.In this NWM we assessed the comparative effectiveness of various therapies for RCDI.The primary outcome was the efficacy order of the different types of fecal microbiota transplantation(FMT),and the secondary outcome was the effective administration route for fecal microbiota transplantation.Methods:We reviewed studies in Pub Med,Embase,Clinicaltrials.gov,Cochrane Library Trials,Scopus,Sino Med,CNKI and Wanfang.The retrieval period was from the establishment of the databasesto March,2022.The retrieval objects were published RCTs of RCDI treated by FMT.Efficacy outcomes were CDI and diarrhea recurrence.We performed a random-effects NWM.We ranked treatments based on SUCRA(surface under the cumulative ranking curve).Results:Twelve eligible RCTs were entered into an NWM.They included 1070 RCDI patients,in whom three therapeutic interventions were used,fresh FMT,frozen FMT and so on.There was no significant difference between frozen fecal bacteria transplantation and fresh fecal bacteria transplantation.Comparing administration of FMT by colonoscopy versus enema resulted in a(OR,95% CI,7.95(1.74,36.26)),indicating a advantage in favor of colonoscopy.The comparison between the FMT by colonoscopy and FMT by oral capsules,indicating that delivery of the FMT by colonoscopy was statistically significantly more effective(OR,95% CI,3.17(0.58,17.29)).The comparison between the FMT by enema and the FMT by oral capsules,indicating that delivery of the FMT by oral capsules was more effective(OR,95% CI,2.50(0.58,10.87)).Conclusions:The use of fresh or frozen feces for bacterial transplantation was superior to antibiotics and placebo for the treatment of RCDI.The method of fecal bacteria transplantation by colonoscopy ranked first.Future research should focus on how to standardize the production of capsules or frozen feces to better guide the treatment of FMT in RCDI patients.