TY - JOUR
T1 - Efficacy of Fecal Microbiota Transplantation for Clostridium difficile Infection in Children
AU - Nicholson, Maribeth R.
AU - Mitchell, Paul D.
AU - Alexander, Erin
AU - Ballal, Sonia
AU - Bartlett, Mark
AU - Becker, Penny
AU - Davidovics, Zev
AU - Docktor, Michael
AU - Dole, Michael
AU - Felix, Grace
AU - Gisser, Jonathan
AU - Hourigan, Suchitra K.
AU - Jensen, M. Kyle
AU - Kaplan, Jess L.
AU - Kelsen, Judith
AU - Kennedy, Melissa
AU - Khanna, Sahil
AU - Knackstedt, Elizabeth
AU - Leier, McKenzie
AU - Lewis, Jeffery
AU - Lodarek, Ashley
AU - Michail, Sonia
AU - Oliva-Hemker, Maria
AU - Patton, Tiffany
AU - Queliza, Karen
AU - Russell, George H.
AU - Singh, Namita
AU - Solomon, Aliza
AU - Suskind, David L.
AU - Werlin, Steven
AU - Kellermayer, Richard
AU - Kahn, Stacy A.
N1 - Funding Information:
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).
Publisher Copyright:
© 2020 AGA Institute
PY - 2020/3
Y1 - 2020/3
N2 - 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.
AB - 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.
KW - Bacteria
KW - Dysbiosis
KW - Inflammatory Bowel Disease
KW - Microbiome
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U2 - 10.1016/j.cgh.2019.04.037
DO - 10.1016/j.cgh.2019.04.037
M3 - Article
C2 - 31009795
AN - SCOPUS:85079227919
SN - 1542-3565
VL - 18
SP - 612-619.e1
JO - Clinical Gastroenterology and Hepatology
JF - Clinical Gastroenterology and Hepatology
IS - 3
ER -