title: Systematic review with meta-analysis: long-term outcomes of faecal microbiota transplantation for Clostridium difficile infection.
abstract: BACKGROUND
  Clostridium difficile infection is a major cause of nosocomial diarrhoea.
  
  
  OBJECTIVE
  To evaluate long-term (≥90 days) efficacy and safety of faecal microbiota transplantation for C. difficile infection and explore the factors affecting the faecal microbiota transplantation outcomes.
  
  
  METHODS
  MEDLINE, the Cochrane Library and EMBASE were searched and only observational studies that utilised faecal microbiota transplantation for C. difficile infection with long-term follow-up duration (≥90 days) were included. Primary cure rate, overall recurrence rate and early (<90 days) and late (≥90 days) recurrence rate were calculated.
  
  
  RESULTS
  Eighteen observational studies with 611 patients were included. The primary cure rate was 91.2% (95% confidence interval, CI 86.7-94.8%). The overall recurrence rate was 5.5% (95% CI 2.2-10.3%). The early recurrence rate and late recurrence rate were 2.7% (95% CI 0.7-6.0%) and 1.7% (95% CI 0.4-4.2%) respectively. Most adverse events were expected, short-lived, self-limited and manageable. The association between faecal microbiota transplantation therapy and adverse events such as inflammatory bowel disease flare, infectious disease and autoimmune disease was a concern but remained insignificant. Old age (≥65 years) was identified as a risk factor for after faecal microbiota transplantation therapy. Upper gastrointestinal administration also results in less frequent primary cure.
  
  
  CONCLUSIONS
  Faecal microbiota transplantation seems to be a highly effective and robust therapy for recurrent C. difficile infection. However, more quality studies, such as randomised controlled trials and cohort studies with control groups, are needed to confirm its long-term efficacy and safety.
authors.affiliation: Division of Gastroenterology and Hepatology, Renji Hospital, Shanghai Institute of Digestive Disease, Shanghai Jiao-Tong University School of Medicine, Shanghai, China.|Key Laboratory of Gastroenterology & Hepatology, Ministry of Health, Shanghai, China.|State Key Laboratory for Oncogenes and Related Genes, Shanghai, China.
authors.forename: Y-T
authors.initials: YT
authors.lastname: Li
authors.affiliation: Division of Gastroenterology and Hepatology, Renji Hospital, Shanghai Institute of Digestive Disease, Shanghai Jiao-Tong University School of Medicine, Shanghai, China.|Key Laboratory of Gastroenterology & Hepatology, Ministry of Health, Shanghai, China.|State Key Laboratory for Oncogenes and Related Genes, Shanghai, China.
authors.forename: H-F
authors.initials: HF
authors.lastname: Cai
authors.affiliation: Division of Gastroenterology and Hepatology, Renji Hospital, Shanghai Institute of Digestive Disease, Shanghai Jiao-Tong University School of Medicine, Shanghai, China.|Key Laboratory of Gastroenterology & Hepatology, Ministry of Health, Shanghai, China.|State Key Laboratory for Oncogenes and Related Genes, Shanghai, China.
authors.forename: Z-H
authors.initials: ZH
authors.lastname: Wang
authors.affiliation: Division of Gastroenterology and Hepatology, Renji Hospital, Shanghai Institute of Digestive Disease, Shanghai Jiao-Tong University School of Medicine, Shanghai, China.|Key Laboratory of Gastroenterology & Hepatology, Ministry of Health, Shanghai, China.|State Key Laboratory for Oncogenes and Related Genes, Shanghai, China.
authors.forename: J
authors.initials: J
authors.lastname: Xu
authors.affiliation: Division of Gastroenterology and Hepatology, Renji Hospital, Shanghai Institute of Digestive Disease, Shanghai Jiao-Tong University School of Medicine, Shanghai, China.|Key Laboratory of Gastroenterology & Hepatology, Ministry of Health, Shanghai, China.|State Key Laboratory for Oncogenes and Related Genes, Shanghai, China.
authors.forename: J-Y
authors.initials: JY
authors.lastname: Fang
mesh_terms: D000367:Age Factors; D016360:Clostridioides difficile; D003015:Clostridium Infections / Q000628:therapy*; D000069467:Fecal Microbiota Transplantation / Q000009:adverse effects / Q000379:methods*; D005243:Feces; D006801:Humans; D064887:Observational Studies as Topic; D012008:Recurrence; D012307:Risk Factors