Taming the Beast: The Safety and Efficacy of Fecal Microbiota Transplantation in Severe and Complicated Clostridium difficile Infection
Bibliographic record
Abstract
Introduction: Fecal microbiota transplantation (FMT) is an effective treatment for refractory and recurrent clostridium difficile infection (CDI). Surgical intervention, which is associated with significant morbidity and mortality, may be needed in case of severe and complicated CDI (SCCDI). However, there is very limited data regarding the use of FMT in SCCDI. Therefore, we conducted a systematic review of the literature to report the safety and efficacy of FMT in the treatment of SCCDI. Methods: A comprehensive search was performed by a medical librarian. Medline, Embase, Scopus, and Cochrane Library were queried from January 2010 to May 2018 utilizing controlled vocabulary and natural language terms for FMT and CDI. SCCDI was identified based on the documentation of a case as severe or complicated according to the American College of Gastroenterology guidelines. The New Castle Ottawa Scale was used to grade the quality of included studies. Results: Out of the 749 studies, 18 studies of 243 patients met inclusion criteria (Table 1). Overall, 78 (32%) patients suffered from complicated CDI. All patients failed antibiotic therapy prior to FMT. FMT was delivered via the lower GI route more commonly than the upper GI route (85% and 15%, respectively). Forty-six (19%) patients received vancomycin or fidaxomicin concurrently with FMT treatment. Table 2 summarizesFMT treatment characteristics. Clinical resolution after FMT was reported in 192 (79%) patients whereas 22 (9%) had improvement without complete resolution. Overall clinical response rate was 88%. Median reported time to clinical response was 3 days (IQR, 1-23). Among patients who had clinical response, 23% (47/207) developed a CDI recurrence. Immediate procedure-related adverse events were not reported in any of the reviewed studies (Table 3). Of the studies that reported short term post-FMT adverse events, 19 (8%) patients had GI complaints; 13 were self-limiting and 6 required hospitalization. The most common GI complaint was non-infectious diarrhea (n = 7). Three patients required surgery for FMT failure or CDI recurrence. All-cause mortality occurred in 25 patients; among whom 5 (2%) were attributed to complicated CDI. Conclusion: FMT is reasonably safe and effective in the treatment of severe and complicated CDI, and can be considered as an alternative to avoid surgical intervention and its associated morbidity and mortality.198_A Figure 1 No Caption available.198_B Figure 2 No Caption available.198_C Figure 3 No Caption available.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.010 | 0.037 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.005 | 0.006 |
| Bibliometrics | 0.005 | 0.004 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".