Efficacy of Fecal Microbiota Transplantation for Clostridium difficile Infection in Children

Maribeth R. Nicholson, Paul D. Mitchell, Erin Alexander, Sonia Ballal, Mark Bartlett, Penny Becker, Zev Davidovics, Michael Docktor, Michael Dole, Grace Felix, Jonathan Gisser, Suchitra K. Hourigan, M. Kyle Jensen, Jess L. Kaplan, Judith Kelsen, Melissa Kennedy, Sahil Khanna, Elizabeth Knackstedt, McKenzie Leier, Jeffery LewisAshley Lodarek, Sonia Michail, Maria Oliva-Hemker, Tiffany Patton, Karen Queliza, George H. Russell, Namita Singh, Aliza Solomon, David L. Suskind, Steven Werlin, Richard Kellermayer, Stacy A. Kahn

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish (US)
Pages (from-to)612-619.e1
JournalClinical Gastroenterology and Hepatology
Volume18
Issue number3
DOIs
StatePublished - Mar 2020

Keywords

  • Bacteria
  • Dysbiosis
  • Inflammatory Bowel Disease
  • Microbiome

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

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