Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2023 Apr 1;76(4):440-446.
doi: 10.1097/MPG.0000000000003714. Epub 2023 Jan 31.

Fecal Microbiota Transplantation for Clostridioides difficile Infection in Immunocompromised Pediatric Patients

Katie R Conover  1 , Imad Absah  2 , Sonia Ballal  3 , David Brumbaugh  4 , Stanley Cho  5 , Maria C Cardenas  2 , Elizabeth Doby Knackstedt  6 , Alka Goyal  7 , M Kyle Jensen  8 , Jess L Kaplan  9 , Richard Kellermayer  6 , Larry K Kociolek  10 , Sonia Michail  11 , Maria Oliva-Hemker  12 , Anna W Reed  12 , Madison Weatherly  3 , Stacy A Kahn  3 , Maribeth R Nicholson  13
Affiliations
Multicenter Study

Fecal Microbiota Transplantation for Clostridioides difficile Infection in Immunocompromised Pediatric Patients

Katie R Conover et al. J Pediatr Gastroenterol Nutr. .

Abstract

Objectives: We sought to evaluate the safety and effectiveness of fecal microbiota transplantation (FMT) for recurrent Clostridioides difficile infection (CDI) in pediatric immunocompromised (IC) patients.

Methods: This is a multicenter retrospective cohort study of pediatric participants who underwent FMT between March 2013 and April 2020 with 12-week follow-up. Pediatric patients were included if they met the definition of IC and were treated with FMT for an indication of recurrent CDI. We excluded patients over 18 years of age, those with incomplete records, insufficient follow-up, or not meeting study definition of IC. We also excluded those treated for Clostridioides difficile recurrence without meeting the study definition and those with inflammatory bowel disease without another immunocompromising condition.

Results: Of 59 pediatric patients identified at 9 centers, there were 42 who met inclusion and no exclusion criteria. Included patients had a median age of 6.7 years. Etiology of IC included: solid organ transplantation (18, 43%), malignancy (12, 28%), primary immunodeficiency (10, 24%), or other chronic conditions (2, 5%). Success rate was 79% after first FMT and 86% after 1 or more FMT. There were no statistically significant differences in patient characteristics or procedural components when patients with a failed FMT were compared to those with a successful FMT. There were 15 total serious adverse events (SAEs) in 13 out of 42 (31%) patients that occurred during the follow-up period; 4 (9.5%) of which were likely treatment-related. There were no deaths or infections with multidrug resistant organisms during follow-up and all patients with a SAE fully recovered.

Conclusions: The success rate of FMT for recurrent CDI in this pediatric IC cohort is high and mirrors data for IC adults and immunocompetent children. FMT-related SAEs do occur (9.5%) and highlight the need for careful consideration of risk and benefit.

PubMed Disclaimer

Conflict of interest statement

The authors report no conflicts of interest.

References

    1. Nicholson MR, Mitchell PD, Alexander E, et al. Efficacy of Fecal Microbiota Transplantation for Clostridium difficile Infection in Children. Clin Gastroenterol Hepatol. 2020;18(3):612–619.e1. doi:10.1016/j.cgh.2019.04.037 - DOI - PMC - PubMed
    1. Quraishi MN, Widlak M, Bhala N, et al. Systematic review with meta-analysis: the efficacy of faecal microbiota transplantation for the treatment of recurrent and refractory Clostridium difficile infection. Aliment Pharmacol Ther. 2017;46(5):479–493. doi:10.1111/apt.14201 - DOI - PubMed
    1. Bakken JS, Borody T, Brandt LJ, et al. Treating Clostridium difficile Infection With Fecal Microbiota Transplantation. Clin Gastroenterol Hepatol. 2011;9(12):1044–1049. doi:10.1016/j.cgh.2011.08.014 - DOI - PMC - PubMed
    1. Kelly CR, Khoruts A, Staley C, et al. Effect of Fecal Microbiota Transplantation on Recurrence in Multiply Recurrent Clostridium difficile Infection: A Randomized Trial. Ann Intern Med. 2016;165(9):609. doi:10.7326/M16-0271 - DOI - PMC - PubMed
    1. Shogbesan O, Poudel DR, Victor S, et al. A Systematic Review of the Efficacy and Safety of Fecal Microbiota Transplant for Clostridium difficile Infection in Immunocompromised Patients. Can J Gastroenterol Hepatol. 2018;2018:1–10. doi:10.1155/2018/1394379 - DOI - PMC - PubMed

Publication types