Original article
Alimentary tract
Efficacy of Fecal Microbiota Transplantation for Clostridium difficile Infection in Children

https://doi.org/10.1016/j.cgh.2019.04.037Get rights and content

Background & Aims

Fecal microbiota transplantation (FMT) is commonly used to treat Clostridium difficile infection (CDI). CDI is an increasing cause of diarrheal illness in pediatric patients, but the effects of FMT have not been well studied in children. We performed a multi-center retrospective cohort study of pediatric and young adult patients to evaluate the efficacy, safety, and factors associated with a successful FMT for the treatment of CDI.

Methods

We performed a retrospective study of 372 patients, 11 months to 23 years old, who underwent FMT at 18 pediatric centers, from February 1, 2004, to February 28, 2017; 2-month outcome data were available from 335 patients. Successful FMT was defined as no recurrence of CDI in the 2 months following FMT. We performed stepwise logistic regression to identify factors associated with successful FMT.

Results

Of 335 patients who underwent FMT and were followed for 2 months or more, 271 (81%) had a successful outcome following a single FMT and 86.6% had a successful outcome following a first or repeated FMT. Patients who received FMT with fresh donor stool (odds ratio [OR], 2.66; 95% CI, 1.39–5.08), underwent FMT via colonoscopy (OR, 2.41; 95% CI, 1.26–4.61), did not have a feeding tube (OR, 2.08; 95% CI, 1.05–4.11), or had 1 less episode of CDI before FMT (OR, 1.20; 95% CI, 1.04–1.39) had increased odds for successful FMT. Seventeen patients (4.7%) had a severe adverse event during the 3-month follow-up period, including 10 hospitalizations.

Conclusions

Based on the findings from a large multi-center retrospective cohort, FMT is effective and safe for the treatment of CDI in children and young adults. Further studies are required to optimize the timing and method of FMT for pediatric patients—factors associated with success differ from those of adult patients.

Section snippets

Setting and Participants

This multicenter retrospective study included pediatric and young adult patients (ages 11 months–23 years) who underwent FMT at 18 pediatric centers across the United States for a diagnosis of CDI from February 1, 2004, to February 28, 2017. Centers were recruited through the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition FMT Special Interest Group (Supplementary Table 1). The institutional review boards of all institutions approved the study.

Data Collection

Study data were

Participants

A total of 372 patients were included. Patients had a median age of 10 years (interquartile range, 3–15), with a range of 11 months to 23 years (Table 1). The most common comorbidity was IBD, which was present in 120 (32%) patients. There were 21 patients newly diagnosed with IBD at the time of colonoscopy for FMT. Most children (71%) underwent a vancomycin taper before undergoing FMT, and the median time from initial CDI until FMT was 7 months (interquartile range, 4–12) (Table 2).

Efficacy

Of the 372

Discussion

This large multicenter cohort study demonstrated very good efficacy of FMT for the treatment of CDI in 335 children and young adults with no episodes of recurrent CDI in 81% of the patients. In the 64 patients that experienced CDI recurrence, 34 (53%) underwent repeat FMT, which was successful in 19 (56%). Thus, the overall success rate of 1 or 2 FMT in the treatment of recurrent CDI was 87%. This is similar to what has been previously reported in adults,28, 29, 30, 31 and demonstrates that FMT

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    Conflicts of interest The authors disclose no conflicts.

    Funding Partially supported by Cures Within Reach (PI: Kahn), a National Institutes of Health (NIH) CTSA award (UL1TR000445; PI: Hartmann), and NIH/NCATS grant support (UL1 TR000445) from NCATS/NIH for REDCap (Vanderbilt University). Partially supported through generous gifts from The Hamel Family (Kahn) and The Neil and Anna Rasmussen Foundation (Kahn).

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    Authors share co-senior authorship.

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