{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T04:41:29Z","timestamp":1792384889862,"version":"4.4.0"},"reference-count":44,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T00:00:00Z","timestamp":1792281600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T00:00:00Z","timestamp":1792281600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100006579","name":"Ministry of Industry and Information Technology of the People's Republic of China","doi-asserted-by":"publisher","award":["2025\u2011AISJK\u201102015"],"award-info":[{"award-number":["2025\u2011AISJK\u201102015"]}],"id":[{"id":"10.13039\/501100006579","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Evidence Based Medicine"],"abstract":"ABSTRACT<\/jats:title>\n \n Objective<\/jats:title>\n Fecal microbiota transplantation (FMT) is an emerging multi\u2010disease therapy, yet the quality and consistency of its available clinical practice guidelines (CPGs) remain unknown. This study aimed to systematically evaluate the quality, content coverage and recommendation consistency of FMT\u2010related guidelines and develop an optimization framework for evidence\u2010informed future guideline revision and standardized FMT clinical practice.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n We searched PubMed, Embase, Web of Science Core Collection, The Cochrane Library, CNKI, WanFang Data, and official websites of guideline development organizations and professional societies from inception to March 11, 2026. Two reviewers independently screened and selected CPGs with actionable recommendations and conducted quality evaluation via the Appraisal of Guidelines for Research & Evaluation (AGREE) II instrument. Intraclass correlation coefficient (ICC) with 95% confidence intervals (CIs) was computed for each AGREE II domain and interpreted according to Fleiss\u2019 criteria. Inter\u2010guideline agreement was reported as the percentage of CPGs endorsing each recommendation.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Eighteen CPGs (3 general, 15 FMT\u2010specific) with 191 recommendations were included. Applicability obtained the lowest AGREE II score (37.8%), followed by rigor of development (47.4%) and stakeholder involvement (49.7%). General guidelines scored higher than FMT\u2010specific guidelines in applicability (62.5%\u00a0vs. 32.9%) and stakeholder involvement (59.3%\u00a0vs. 47.8%), but lower in rigor of development (38.9%\u00a0vs. 49.1%). The coverage of recommendations showed marked inter\u2011guideline heterogeneity. Recurrent\n Clostridioides difficile<\/jats:italic>\n infection (rCDI) was the most consistently recommended indication with the highest level of evidence (10\/16). Over 75% of guidelines ignored transplant\u2010center management, and non\u2010CDI indications and key operational steps lacked sufficient high\u2010certainty evidence. ICCs (0.86\u20130.97) showed excellent evaluator consistency.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Current FMT guidelines exhibit significant methodological deficiencies, heterogeneous recommendation coverage, and limited consensus beyond rCDI. FMT\u2010specific guidelines show better developmental rigor but poorer applicability than general guidelines. Future FMT guideline development should establish core topic sets, adopt multidisciplinary collaborative mechanisms, and develop implementation toolkits with regular update protocols.<\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/jebm.70202","type":"journal-article","created":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T04:21:25Z","timestamp":1792383685000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Evaluation of Clinical Practice Guidelines on Fecal Microbiota Transplantation in Adults: A Cross\u2010Sectional Study"],"prefix":"10.1111","author":[{"given":"Mingjuan","family":"Zhao","sequence":"first","affiliation":[{"name":"Center for Evidence\u2010Based and Translational Medicine Zhongnan Hospital of Wuhan University Wuhan China"},{"name":"Department of Neurosurgery Zhongnan Hospital of Wuhan University Wuhan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shaojie","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Zhongnan Hospital of Wuhan University Wuhan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guang","family":"Fu","sequence":"additional","affiliation":[{"name":"Department of Gastrointestinal Surgery Wuhan Puren Hospital Wuhan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tong","family":"Deng","sequence":"additional","affiliation":[{"name":"Department of Thyroid and Breast Surgery Zhongnan Hospital of Wuhan University Wuhan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yinghui","family":"Jin","sequence":"additional","affiliation":[{"name":"Center for Evidence\u2010Based and Translational Medicine Zhongnan Hospital of Wuhan University Wuhan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yingjiang","family":"Ye","sequence":"additional","affiliation":[{"name":"Department of Gastrointestinal Surgery Peking University People's Hospital Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhiqiang","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Zhongnan Hospital of Wuhan University Wuhan China"},{"name":"Department of Clinical Nutrition Zhongnan Hospital of Wuhan University Wuhan China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,18]]},"reference":[{"issue":"11","key":"e_1_2_7_2_1","doi-asserted-by":"crossref","first-page":"1755","DOI":"10.1038\/ajg.2012.251","article-title":"Should We Standardize the 1,700\u2010Year\u2010Old Fecal Microbiota Transplantation?","volume":"107","author":"Zhang F.","year":"2012","journal-title":"The American Journal of Gastroenterology"},{"key":"e_1_2_7_3_1","doi-asserted-by":"crossref","first-page":"462","DOI":"10.1007\/s13238-018-0541-8","article-title":"Microbiota Transplantation: Concept, Methodology and Strategy for Its Modernization","volume":"9","author":"Zhang F.","year":"2018","journal-title":"Protein Cell"},{"issue":"5","key":"e_1_2_7_4_1","first-page":"854","article-title":"Fecal Enema as an Adjunct in the Treatment of Pseudomembranous Enterocolitis","volume":"44","author":"Eiseman B.","year":"1958","journal-title":"Surgery"},{"issue":"8354","key":"e_1_2_7_5_1","doi-asserted-by":"crossref","first-page":"845","DOI":"10.1016\/S0140-6736(83)90753-5","article-title":"Relapsing Clostridium difficile Enterocolitis Cured by Rectal Infusion of Homologous Faeces","volume":"2","author":"Schwan A.","year":"1983","journal-title":"Lancet"},{"issue":"5","key":"e_1_2_7_6_1","doi-asserted-by":"crossref","first-page":"761","DOI":"10.1038\/ajg.2011.482","article-title":"Standardized Frozen Preparation for Transplantation of Fecal Microbiota for Recurrent Clostridium difficile Infection","volume":"107","author":"Hamilton M. J.","year":"2012","journal-title":"The American Journal of Gastroenterology"},{"issue":"16","key":"e_1_2_7_7_1","doi-asserted-by":"crossref","first-page":"1927","DOI":"10.1097\/CM9.0000000000002339","article-title":"Encyclopedia of Fecal Microbiota Transplantation: A Review of Effectiveness in the Treatment of 85 Diseases","volume":"135","author":"Wang Y.","year":"2022","journal-title":"Chinese Medical Journal"},{"key":"e_1_2_7_8_1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.nutres.2020.06.018","article-title":"Fecal Microbiota Transplantation Improves Metabolic Syndrome Parameters: Systematic Review With Meta\u2010Analysis Based on Randomized Clinical Trials","volume":"83","author":"Proen\u00e7a I. M.","year":"2020","journal-title":"Nutrition Research"},{"key":"e_1_2_7_9_1","doi-asserted-by":"crossref","DOI":"10.3389\/fcimb.2022.827395","article-title":"Efficacy of Fecal Microbiota Transplantation in Irritable Bowel Syndrome: A Meta\u2010Analysis of Randomized Controlled Trials","volume":"12","author":"Wu J.","year":"2022","journal-title":"Frontiers In Cellular And Infection Microbiology"},{"key":"e_1_2_7_10_1","doi-asserted-by":"crossref","DOI":"10.1016\/j.pnpbp.2021.110258","article-title":"Gut Microbiota Alteration and Modulation in Psychiatric Disorders: Current Evidence on Fecal Microbiota Transplantation","volume":"109","author":"Settanni C. R.","year":"2021","journal-title":"Progress in Neuro\u2010Psychopharmacology & Biological Psychiatry"},{"issue":"8","key":"e_1_2_7_11_1","doi-asserted-by":"crossref","first-page":"2021","DOI":"10.1002\/ijc.32003","article-title":"Fecal Microbiota Transplantation in Cancer Management: Current Status and Perspectives","volume":"145","author":"Chen D.","year":"2019","journal-title":"International Journal of Cancer"},{"key":"e_1_2_7_12_1","doi-asserted-by":"crossref","DOI":"10.1016\/j.ebiom.2024.104967","article-title":"Fecal Microbiota Transplantation: No Longer Cinderella in Tumour Immunotherapy","volume":"100","author":"Yang Y.","year":"2024","journal-title":"EBioMedicine"},{"key":"e_1_2_7_13_1","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1146\/annurev-med-111717-122956","article-title":"Clinical Application and Potential of Fecal Microbiota Transplantation","volume":"70","author":"Ooijevaar R. E.","year":"2019","journal-title":"Annual Review of Medicine"},{"key":"e_1_2_7_14_1","volume-title":"Clinical Practice Guidelines We Can Trust","author":"Institute of Medicine","year":"2011"},{"issue":"4","key":"e_1_2_7_15_1","doi-asserted-by":"crossref","first-page":"569","DOI":"10.1136\/gutjnl-2016-313017","article-title":"European Consensus Conference on Faecal Microbiota Transplantation in Clinical Practice","volume":"66","author":"Cammarota G.","year":"2017","journal-title":"Gut"},{"issue":"11","key":"e_1_2_7_16_1","doi-asserted-by":"crossref","first-page":"1920","DOI":"10.1136\/gutjnl-2018-316818","article-title":"The Use of Faecal Microbiota Transplant as Treatment for Recurrent or Refractory Clostridium difficile Infection and Other Potential Indications: Joint British Society of Gastroenterology (BSG) and Healthcare Infection Society (HIS) Guidelines","volume":"67","author":"Mullish B. H.","year":"2018","journal-title":"Gut"},{"issue":"12","key":"e_1_2_7_17_1","doi-asserted-by":"crossref","first-page":"2111","DOI":"10.1136\/gutjnl-2019-319548","article-title":"International Consensus Conference on Stool Banking for Faecal Microbiota Transplantation in Clinical Practice","volume":"68","author":"Cammarota G.","year":"2019","journal-title":"Gut"},{"issue":"5","key":"e_1_2_7_18_1","doi-asserted-by":"crossref","first-page":"801","DOI":"10.1136\/gutjnl-2019-320260","article-title":"Australian Consensus Statements for the Regulation, Production and Use of Faecal Microbiota Transplantation in Clinical Practice","volume":"69","author":"Haifer C.","year":"2020","journal-title":"Gut"},{"issue":"1","key":"e_1_2_7_19_1","doi-asserted-by":"crossref","first-page":"219","DOI":"10.4102\/sajid.v35i1.219","article-title":"South African Society of Clinical Microbiology Clostridioides difficile Infection Diagnosis, Management and Infection Prevention and Control Guideline","volume":"35","author":"Nana T.","year":"2020","journal-title":"Southern African Journal of Infectious Diseases"},{"issue":"1","key":"e_1_2_7_20_1","first-page":"5","article-title":"Chinese Expert Consensus on Standardized Methodology and Clinical Application of Fecal Microbiota Transplantation","volume":"23","year":"2020","journal-title":"Chinese Journal of Gastrointestinal Surgery"},{"key":"e_1_2_7_21_1","unstructured":"The AGREE Collaboration \u201cAppraisal of Guidelines for Research and Evaluation (AGREE\u2010II) Instrument \u201d Available from:https:\/\/www.agreetrust.org\/wp\u2010content\/uploads\/2017\/12\/AGREE\u2010II\u2010Users\u2010Manual\u2010and\u201023\u2010item\u2010Instrument\u20102009\u2010Update\u20102017.pdf."},{"key":"e_1_2_7_22_1","volume-title":"Statistical Methods for Rates and Proportions","author":"Fleiss J. L.","year":"1981"},{"issue":"1","key":"e_1_2_7_23_1","first-page":"14","article-title":"Chinese Expert Consensus on Clinical Practice of the Selection and Establishment of Fecal Microbiota Transplantation Delivery Routes","volume":"23","author":"Parenteral and Enteral Nutrition Branch of Chinese Medical Association","year":"2020","journal-title":"Chinese Journal of Gastrointestinal Surgery"},{"issue":"19","key":"e_1_2_7_24_1","doi-asserted-by":"crossref","first-page":"2330","DOI":"10.1097\/CM9.0000000000000954","article-title":"Nanjing Consensus on Methodology of Washed Microbiota Transplantation","volume":"133","author":"Fecal Microbiota Transplantation\u2010Standardization Study Group","year":"2020","journal-title":"Chinese Medical Journal"},{"issue":"6","key":"e_1_2_7_25_1","doi-asserted-by":"crossref","first-page":"1124","DOI":"10.14309\/ajg.0000000000001278","article-title":"ACG Clinical Guidelines: Prevention, Diagnosis, and Treatment of Clostridioides difficile Infections","volume":"116","author":"Kelly C. R.","year":"2021","journal-title":"The American Journal of Gastroenterology"},{"key":"e_1_2_7_26_1","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1016\/j.cmi.2021.09.038","article-title":"European Society of Clinical Microbiology and Infectious Diseases: 2021 Update on the Treatment Guidance Document for Clostridioides difficile Infection in Adults","volume":"27","author":"Prehn J.","year":"2021","journal-title":"Clinical Microbiology and Infection"},{"issue":"9","key":"e_1_2_7_27_1","doi-asserted-by":"crossref","first-page":"1056","DOI":"10.1080\/00365521.2021.1922749","article-title":"Danish National Guideline for the Treatment of Clostridioides difficile Infection and Use of Faecal Microbiota Transplantation (FMT)","volume":"56","author":"Baunwall S. M. D.","year":"2021","journal-title":"Scandinavian Journal of Gastroenterology"},{"issue":"1","key":"e_1_2_7_28_1","doi-asserted-by":"crossref","first-page":"28","DOI":"10.5056\/jnm21221","article-title":"Clinical Practice Guidelines for Fecal Microbiota Transplantation in Korea","volume":"28","author":"Gweon T. G.","year":"2022","journal-title":"Journal of Neurogastroenterology and Motility"},{"issue":"9","key":"e_1_2_7_29_1","first-page":"757","article-title":"Chinese Expert Consensus on Screening and Management of Fecal Microbiota Transplantation Donors (2022 Edition)","volume":"25","year":"2022","journal-title":"Chinese Journal of Gastrointestinal Surgery"},{"issue":"3","key":"e_1_2_7_30_1","doi-asserted-by":"crossref","first-page":"409","DOI":"10.1053\/j.gastro.2024.01.008","article-title":"AGA Clinical Practice Guideline on Fecal Microbiota\u2010Based Therapies for Select Gastrointestinal Diseases","volume":"166","author":"Peery A. F.","year":"2024","journal-title":"Gastroenterology"},{"issue":"4","key":"e_1_2_7_31_1","first-page":"326","article-title":"Chinese Expert Consensus on the Clinical Diagnosis and Treatment of Gut Microecology in Chronic Constipation (2024 Edition)","volume":"27","year":"2024","journal-title":"Chinese Journal of Gastrointestinal Surgery"},{"issue":"1","key":"e_1_2_7_32_1","first-page":"2","article-title":"Guidelines for fecal Microbiota Transplantation Therapy in Patients With Liver Cirrhosis","volume":"12","year":"2025","journal-title":"Chinese Research Hospitals"},{"issue":"8","key":"e_1_2_7_33_1","first-page":"738","article-title":"Expert Consensus on the Clinical Application of Gut Microbiota Transplant Therapy in Chronic Liver Disease (Version 2025)","volume":"33","author":"Liver Related Digestive Diseases Group, Chinese Society of Hepatology, Chinese Medical Association","year":"2025","journal-title":"Chinese Journal of Hepatology"},{"issue":"12","key":"e_1_2_7_34_1","first-page":"1112","article-title":"Guidelines for Fecal Microbiota Transplantation in the Treatment of Immune\u2010Mediated Skin Diseases (2025 Edition)","volume":"58","author":"Immunology Group, Chinese Society of Dermatology","year":"2025","journal-title":"Chinese Journal of Dermatology"},{"key":"e_1_2_7_35_1","doi-asserted-by":"crossref","DOI":"10.1016\/j.jclinepi.2025.111830","article-title":"What Makes a Good Guideline?\u2014A Systematic Review and Analysis of 120 Clinical Practice Guidelines in Orthogeriatric Care and Related Fields Using the AGREE II Tool","volume":"184","author":"Fotteler M. L.","year":"2025","journal-title":"Journal of Clinical Epidemiology"},{"issue":"6","key":"e_1_2_7_36_1","doi-asserted-by":"crossref","first-page":"1353","DOI":"10.1007\/s10557-024-07605-w","article-title":"Methodological Quality of Pulmonary Arterial Hypertension Treatment Evidence\u2010Based Guidelines: A Systematic Review Using the AGREE II and AGREE REX Tools","volume":"39","author":"Vilela A. P. O.","year":"2025","journal-title":"Cardiovascular Drugs and Therapy"},{"key":"e_1_2_7_37_1","article-title":"Fecal Microbiota Transplantation for the Treatment of Recurrent Clostridioides difficile (Clostridium difficile)","volume":"4","author":"Minkoff N. Z.","year":"2023","journal-title":"Cochrane Database of Systematic Reviews"},{"key":"e_1_2_7_38_1","doi-asserted-by":"crossref","DOI":"10.1016\/j.ijid.2026.108574","article-title":"A Global Evaluation of the Use of Faecal Microbiota Transplant (FMT)","volume":"167","author":"Merrick B.","year":"2026","journal-title":"International Journal of Infectious Diseases"},{"key":"e_1_2_7_39_1","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1056\/NEJMoa1205037","article-title":"Duodenal Infusion of Donor Feces for Recurrent Clostridium difficile","volume":"368","author":"Nood E.","year":"2013","journal-title":"The New England Journal of Medicine"},{"key":"e_1_2_7_40_1","doi-asserted-by":"crossref","DOI":"10.1080\/19490976.2025.2493901","article-title":"Fecal Microbiota Transplantation: A Tale of Two Regulatory Pathways","volume":"17","author":"Hoffmann D. E.","year":"2025","journal-title":"Gut Microbes"},{"key":"e_1_2_7_41_1","doi-asserted-by":"crossref","DOI":"10.1016\/j.lanepe.2021.100181","article-title":"The Use of Faecal Microbiota Transplantation (FMT) in Europe: A Europe\u2010Wide Survey","volume":"9","author":"Baunwall S. M. D.","year":"2021","journal-title":"Lancet Regional Health \u2013 Europe"},{"key":"e_1_2_7_42_1","first-page":"2221","article-title":"Analysis of the Similarities, Differences, and Underlying Causes of Major Global Gastric Cancer Clinical Practice Guidelines","volume":"34","author":"Li Y. Q.","year":"2025","journal-title":"China Journal of General Surgery"},{"key":"e_1_2_7_43_1","doi-asserted-by":"crossref","first-page":"53S","DOI":"10.1177\/2192568219831689","article-title":"Development and Implementation of Clinical Practice Guidelines: An Update and Synthesis of the Literature With a Focus in Application to Spinal Conditions","volume":"9","author":"Tetreault L.","year":"2019","journal-title":"Global Spine Journal"},{"issue":"2","key":"e_1_2_7_44_1","doi-asserted-by":"crossref","DOI":"10.1002\/mmr3.70006","article-title":"Nanjing Consensus II on Washed Microbiota Transplantation: Statements From the CHINAGUT Conference","volume":"1","author":"Zhang F. M.","year":"2026","journal-title":"Microbiota Medicine Research"},{"key":"e_1_2_7_45_1","doi-asserted-by":"crossref","first-page":"549","DOI":"10.1111\/apt.17309","article-title":"Faecal Microbiota Transplantation for Recurrent C. difficile Infections: Challenges and Improvement Opportunities for Clinical Practice and Healthcare Systems","volume":"57","author":"Hocking L.","year":"2023","journal-title":"Alimentary Pharmacology & Therapeutics"}],"container-title":["Journal of Evidence-Based Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jebm.70202","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/jebm.70202","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jebm.70202","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T04:21:32Z","timestamp":1792383692000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/jebm.70202"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,18]]},"references-count":44,"alternative-id":["10.1111\/jebm.70202"],"URL":"https:\/\/doi.org\/10.1111\/jebm.70202","archive":["Portico"],"relation":{},"ISSN":["1756-5383","1756-5391"],"issn-type":[{"value":"1756-5383","type":"print"},{"value":"1756-5391","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,18]]},"assertion":[{"value":"2026-06-24","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-17","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-10-18","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70202"}}