Healthcare providers’ perception of faecal microbiota transplantation with clostridium difficile infection and inflammatory bowel disease: a quantitative systematic review

Abstract

Background: Clostridioides difficile infection (CDI) and inflammatory bowel disease (IBD) are global gastroenterological diseases that cause considerable burden on human health, healthcare systems, and society. Faecal microbiota transplantation (FMT) is an effective treatment for recurrent Clostridioides Difficile Infection (rCDI) and a promising therapy for IBD. However, indication for FMT in IBD is still unofficial. Consequently, the National Institute for Health and Care Excellence (NICE) is seeking healthcare providers’ advice on whether to update FMT guidelines. Methods: A systematic review methodology was adopted for this study. Five databases (CINAHL, MEDLINE, Cochrane Library, Scopus, Web of Science) and grey literature were systematically searched for English language literature to 14 May 2021. The quality of the included studies was then appraised using the Institute for Public Health Sciences cross-sectional studies tool, after which the findings of the studies were narratively synthesised. Results: Thirteen cross-sectional studies with 4110 validated questionnaire responses were included. Narrative synthesis found that 39.43% of respondents were familiar with FMT (N = 3746, 95%CI = 37.87%–41%), 58.81% of respondents would recommend FMT to their patients (N = 1141, 95%CI = 55.95%–61.67%), 66.67% of respondents considered lack of clinical evidence was the greatest concern regarding FMT (N = 1941, 95%CI = 64.57%–68.77%), and 40.43% respondents would not implement FMT due to concerns about infection transmission (N = 1128, 95%CI = 37.57%–43.29%). Conclusion: Healthcare providers’ knowledge of FMT is relatively low and education is an effective strategy to improve it. As knowledge of FMT increases, willingness to recommend it also increases. Strengthening FMT clinical efficacy and reducing infection can enhance its public acceptance, application and popularity. However, further research is required to explore the donor screening procedure.

Clostridioides difficile infection: a changing treatment paradigm

“…Long-term safety following FMT is a crucial area of study [ 13 ]. Furthermore, healthcare providers lack knowledge about FMT, necessitating ongoing education [ 22 ]. FMT is also being investigated for treating non-communicable conditions like obesity, diabetes, neuropsychiatric disorders, and more [ 23 ], suggesting its expanding use.…”

Safety and Efficacy of Fecal Microbiota Transplantation in Treatment of Inflammatory Bowel Disease in the Pediatric Population: A Systematic Review and Meta-Analysis

“…These beliefs are understandable given the novelty and uniqueness of FMT, particularly among the pediatric population. Multiple studies have examined hesitations from both patients and providers due to lack of knowledge, concerns over hygiene, and reservations concerning side effects, even in spite of documented patient satisfaction with FMT [ 61 , 62 , 63 ].…”

Inflammatory bowel disease and Clostridium difficile infection: clinical presentation, diagnosis, and management

“… 68 According to the recommendations of the 2018 guidelines of The British Society of Gastroenterology and Healthcare Infection Society, FMT can be provided to patients with rCDI who have at least two recurrences, or patients who have one recurrence and are at risk of further attacks, including patients with severe and complex CDI. 69 Recently, the European Consensus Conference held in Rome highlighted that FMT was recommended as an alternative treatment for rCDI and should be considered for refractory CDI. 70 Furthermore, massive data suggest that FMT may be used in mild to moderate UC patients.…”