Trasplante de microbiota fecal en la infección por Clostridioides difficile y enfermedades inflamatorias intestinales – un meta-meta-análisis
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El trasplante de microbiota fecal (TMF) es una terapia cada vez más indicada para los trastornos intestinales. El objetivo de este meta-meta-análisis es evaluar los resultados clínicos del TMF en la colitis ulcerosa, la enfermedad de Crohn y la infección recurrente por Clostridioides difficile (CDI). Se realizó una búsqueda en la base de datos PubMed de estudios de metaanálisis sobre trastornos intestinales. Tras considerar la superposición de estudios, se incluyeron 11 publicaciones sobre CDI y 13 sobre enfermedades inflamatorias intestinales. Con base en este meta-meta-análisis, se cuantificó el impacto del TMF en los resultados clínicos. Se combinaron los efectos mediante un modelo de efectos aleatorios y se agruparon las estimaciones como razón de momios (OR). En casos de CDI recurrente, se observó remisión clínica en el 86% de los pacientes tratados con TMF, frente al 49% (n=449) en el grupo control [OR 1.82, IC95% 1.69–1.96, P < 0.0001]. Once estudios incluyeron datos de pacientes con colitis ulcerosa, observándose remisión clínica en el 36% (n=903) de los pacientes tratados con TMF frente al 16% (n=217) en el grupo control [OR 3.58, IC95% 2.99–4.28, P < 0.0001]. En pacientes con enfermedad de Crohn, el TMF no mostró diferencias significativas respecto al grupo control. El TMF es una terapia prometedora para la CDI recurrente y la colitis ulcerosa, aunque se necesitan más ensayos clínicos y una estandarización de la técnica y preparación del TMF.
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Yan D, Huang YD, Chen YB, Lv T, Zhu CX, Huang JR, et al. Prediction of Clostridium difficile infection based on gut microbial traits in patients with Clostridium difficile colonization. Hepatobiliary Pancreat Dis Int. 2021;20(3):298-300. https://doi.org/10.1016/j.hbpd.2021.03.004
Pires RN, Falci DR, Monteiro AA, Caurio CFB, Tuon FF, Medeiros EA, et al. High frequency of Clostridium difficile infections in Brazil: Results from a multicenter point-prevalence study. Infect Control Hosp Epidemiol. 2019;40(4):484-5. https://doi.org/10.1017/ice.2019.27
McDonald LC, Gerding DN, Johnson S, Bakken JS, Carroll KC, Coffin SE, et al. Clinical Practice Guidelines for Clostridium difficile Infection in Adults and Children: 2017 Update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA). Clin Infect Dis. 2018;66(7):987-94. https://doi.org/10.1093/cid/cix1085
Costello SP, Hughes PA, Waters O, Bryant RV, Vincent AD, Blatchford P, et al. Effect of Fecal Microbiota Transplantation on 8-Week Remission in Patients With Ulcerative Colitis: A Randomized Clinical Trial. JAMA. 2019;321(2):156-64. https://doi.org/10.1001/jama.2018.20046
Hurych J, Vejmelka J, Hlinakova L, Kramna L, Larionov V, Kulich M, et al. Protocol for faecal microbiota transplantation in irritable bowel syndrome: the MISCEAT study - a randomised, double-blind cross-over study using mixed microbiota from healthy donors. BMJ Open. 2022;12(6):e056594. https://doi.org/10.1136/bmjopen-2021-056594
Xiang L, Yu Y, Ding X, Zhang H, Wen Q, Cui B, et al. Exclusive Enteral Nutrition Plus Immediate vs. Delayed Washed Microbiota Transplantation in Crohn's Disease With Malnutrition: A Randomized Pilot Study. Front Med (Lausanne). 2021;8:666062. https://doi.org/10.3389/fmed.2021.666062
Liu H, Li J, Yuan J, Huang J, Xu Y. Fecal microbiota transplantation as a therapy for treating ulcerative colitis: an overview of systematic reviews. BMC Microbiol. 2023;23(1):371. https://doi.org/10.1186/s12866-023-03107-1
Pomares Bascunana RA, Veses V, Sheth CC. Effectiveness of fecal microbiota transplant for the treatment of Clostridioides difficile diarrhea: a systematic review and meta-analysis. Lett Appl Microbiol. 2021;73(2):149-58. https://doi.org/10.1111/lam.13486
Furuya-Kanamori L, Doi SA, Paterson DL, Helms SK, Yakob L, McKenzie SJ, et al. Upper Versus Lower Gastrointestinal Delivery for Transplantation of Fecal Microbiota in Recurrent or Refractory Clostridium difficile Infection: A Collaborative Analysis of Individual Patient Data From 14 Studies. J Clin Gastroenterol. 2017;51(2):145-50. https://doi.org/10.1097/MCG.0000000000000511
Khan MY, Dirweesh A, Khurshid T, Siddiqui WJ. Comparing fecal microbiota transplantation to standard-of-care treatment for recurrent Clostridium difficile infection: a systematic review and meta-analysis. Eur J Gastroenterol Hepatol. 2018;30(11):1309-17. https://doi.org/10.1097/MEG.0000000000001243
Moayyedi P, Yuan Y, Baharith H, Ford AC. Faecal microbiota transplantation for Clostridium difficile-associated diarrhoea: a systematic review of randomised controlled trials. Med J Aust. 2017;207(4):166-72. https://doi.org/10.5694/mja17.00295
Rossen NG, MacDonald JK, de Vries EM, D'Haens GR, de Vos WM, Zoetendal EG, et al. Fecal microbiota transplantation as novel therapy in gastroenterology: A systematic review. World J Gastroenterol. 2015;21(17):5359-71. https://doi.org/10.3748/wjg.v21.i17.5359
Quraishi MN, Widlak M, Bhala N, Moore D, Price M, Sharma N, et al. Systematic review with meta-analysis: the efficacy of faecal microbiota transplantation for the treatment of recurrent and refractory Clostridium difficile infection. Aliment Pharmacol Ther. 2017;46(5):479-93. https://doi.org/10.1111/apt.14201
Rokkas T, Gisbert JP, Gasbarrini A, Hold GL, Tilg H, Malfertheiner P, et al. A network meta-analysis of randomized controlled trials exploring the role of fecal microbiota transplantation in recurrent Clostridium difficile infection. United European Gastroenterol J. 2019;7(8):1051-63. https://doi.org/10.1177/2050640619854587
Tariq R, Hayat M, Pardi D, Khanna S. Predictors of failure after fecal microbiota transplantation for recurrent Clostridioides difficile infection: a systematic review and meta-analysis. Eur J Clin Microbiol Infect Dis. 2021;40(7):1383-92. https://doi.org/10.1007/s10096-021-04163-z
Tariq R, Pardi DS, Bartlett MG, Khanna S. Low Cure Rates in Controlled Trials of Fecal Microbiota Transplantation for Recurrent Clostridium difficile Infection: A Systematic Review and Meta-analysis. Clin Infect Dis. 2019;68(8):1351-8.https://doi.org/10.1093/cid/ciy721
Hui W, Li T, Liu W, Zhou C, Gao F. Fecal microbiota transplantation for treatment of recurrent C. difficile infection: An updated randomized controlled trial meta-analysis. PLoS One. 2019;14(1):e0210016. https://doi.org/10.1371/journal.pone.0210016
Kassam Z, Lee CH, Yuan Y, Hunt RH. Fecal microbiota transplantation for Clostridium difficile infection: systematic review and meta-analysis. Am J Gastroenterol. 2013;108(4):500-8.https://doi.org/10.1038/ajg.2013.59
Colman RJ, Rubin DT. Fecal microbiota transplantation as therapy for inflammatory bowel disease: a systematic review and meta-analysis. J Crohns Colitis. 2014;8(12):1569-81. https://doi.org/10.1016/j.crohns.2014.08.006
Costello SP, Soo W, Bryant RV, Jairath V, Hart AL, Andrews JM. Systematic review with meta-analysis: faecal microbiota transplantation for the induction of remission for active ulcerative colitis. Aliment Pharmacol Ther. 2017;46(3):213-24. https://doi.org/10.1111/apt.14173
Dang X, Xu M, Liu D, Zhou D, Yang W. Assessing the efficacy and safety of fecal microbiota transplantation and probiotic VSL#3 for active ulcerative colitis: A systematic review and meta-analysis. PLoS One. 2020;15(3):e0228846. https://doi.org/10.1371/journal.pone.0228846
Fang H, Fu L, Wang J. Protocol for Fecal Microbiota Transplantation in Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis. Biomed Res Int. 2018;2018:8941340. https://doi.org/10.1155/2018/8941340
Green JE, Davis JA, Berk M, Hair C, Loughman A, Castle D, et al. Efficacy and safety of fecal microbiota transplantation for the treatment of diseases other than Clostridium difficile infection: a systematic review and meta-analysis. Gut Microbes. 2020;12(1):1-25. https://doi.org/10.1080/19490976.2020.1854640
Imdad A, Nicholson MR, Tanner-Smith EE, Zackular JP, Gomez-Duarte OG, Beaulieu DB, et al. Fecal transplantation for treatment of inflammatory bowel disease. Cochrane Database Syst Rev. 2018;11(11):CD012774. https://doi.org/10.1002/14651858.CD012774.pub2
Narula N, Kassam Z, Yuan Y, Colombel JF, Ponsioen C, Reinisch W, et al. Systematic Review and Meta-analysis: Fecal Microbiota Transplantation for Treatment of Active Ulcerative Colitis. Inflamm Bowel Dis. 2017;23(10):1702-9. https://doi.org/10.1097/MIB.0000000000001228
Paramsothy S, Paramsothy R, Rubin DT, Kamm MA, Kaakoush NO, Mitchell HM, et al. Faecal Microbiota Transplantation for Inflammatory Bowel Disease: A Systematic Review and Meta-analysis. J Crohns Colitis. 2017;11(10):1180-99. https://doi.org/10.1093/ecco-jcc/jjx063
Shi Y, Dong Y, Huang W, Zhu D, Mao H, Su P. Fecal Microbiota Transplantation for Ulcerative Colitis: A Systematic Review and MetaAnalysis. PLoS One. 2016;11(6):e0157259. https://doi.org/10.1371/journal.pone.0157259
Sun D, Li W, Li S, Cen Y, Xu Q, Li Y, et al. Fecal Microbiota Transplantation as a Novel Therapy for Ulcerative Colitis: A Systematic Review and MetaAnalysis. Medicine (Baltimore). 2016;95(23):e3765. https://doi.org/10.1097/MD.0000000000003765
Tang LL, Feng WZ, Cheng JJ, Gong YN. Clinical remission of ulcerative colitis after different modes of faecal microbiota transplantation: a metaanalysis. Int J Colorectal Dis. 2020;35(6):1025-34. https://doi.org/10.1007/s00384-020-03599-7
Cheng F, Huang Z, Wei W, Li Z. Fecal microbiota transplantation for Crohn's disease: a systematic review and meta-analysis. Tech Coloproctol. 2021;25(5):495-504. https://doi.org/10.1007/s10151-020-02395-3
Seyedian SS, Nokhostin F, Malamir MD. A review of the diagnosis, prevention, and treatment methods of inflammatory bowel disease. J Med Life. 2019;12(2):113-22. https://doi.org/10.25122/jml-2018-0075
Nishida A, Imaeda H, Ohno M, Inatomi O, Bamba S, Sugimoto M, et al. Efficacy and safety of single fecal microbiota transplantation for Japanese patients with mild to moderately active ulcerative colitis. J Gastroenterol. 2017;52(4):476-82. https://doi.org/10.1007/s00535-016-1271-4
Cui B, Feng Q, Wang H, Wang M, Peng Z, Li P, et al. Fecal microbiota transplantation through mid-gut for refractory Crohn's disease: safety, feasibility, and efficacy trial results. J Gastroenterol Hepatol. 2015;30(1):51-8. https://doi.org/10.1111/jgh.12727