David E Brumbaugh1, Edwin F De Zoeten2, Amy Pyo-Twist3, Sara Fidanza3, Shannon Hughes4, Susan A Dolan5, Jason Child6, Samuel R Dominguez7. 1. Section of Gastroenterology, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO; Children's Hospital Colorado, Aurora, CO. Electronic address: david.brumbaugh@childrenscolorado.org. 2. Section of Gastroenterology, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO; Children's Hospital Colorado, Aurora, CO. 3. Department of Nursing, Children's Hospital Colorado, Aurora, CO. 4. Section of Infectious Diseases, Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO. 5. Department of Epidemiology, Children's Hospital Colorado, Aurora, CO. 6. Department of Pharmacy, Children's Hospital Colorado, Aurora, CO. 7. Section of Infectious Diseases, Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO; Department of Epidemiology, Children's Hospital Colorado, Aurora, CO.
Abstract
OBJECTIVE: To assess the safety, efficacy, and relative expense of a nurse-led fecal microbiota transplantation (FMT) program for the treatment of recurrent Clostridium difficile infection (CDI). STUDY DESIGN: Retrospective cohort study design in children aged 1-18 years with recurrent CDI. The intervention was an intragastric FMT with stool derived from a donor stool bank. Primary outcome was resolution of diarrhea at 3 months post-transplantation. A secondary analysis compared charge data associated with FMT by intragastric delivery vs administration by colonoscopy or nasoduodenal tube. RESULTS: A total of 47 intragastric FMT procedures were performed in 42 children (median age 9 years) with recurrent CDI. Response to treatment varied by disease status, with 94% success in previously healthy children, 75% in medically complex children, and 54% in children with inflammatory bowel disease (P = .04). FMT via intragastric delivery showed lower facility and professional charges by 85% and 78% compared with delivery via colonoscopy and radiology-placed nasoduodenal tube, respectively. The use of stool derived from a donor stool bank decreased charges by 49% compared with charges associated with the use of a donor who was a relative. CONCLUSION: A nurse-led intragastric FMT procedure using stool derived from a donor stool bank is a relatively inexpensive and efficacious treatment for recurrent CDI in children. Intragastric FMT success in children was attenuated by the presence of underlying disease, particularly inflammatory bowel disease.
OBJECTIVE: To assess the safety, efficacy, and relative expense of a nurse-led fecal microbiota transplantation (FMT) program for the treatment of recurrent Clostridium difficileinfection (CDI). STUDY DESIGN: Retrospective cohort study design in children aged 1-18 years with recurrent CDI. The intervention was an intragastric FMT with stool derived from a donor stool bank. Primary outcome was resolution of diarrhea at 3 months post-transplantation. A secondary analysis compared charge data associated with FMT by intragastric delivery vs administration by colonoscopy or nasoduodenal tube. RESULTS: A total of 47 intragastric FMT procedures were performed in 42 children (median age 9 years) with recurrent CDI. Response to treatment varied by disease status, with 94% success in previously healthy children, 75% in medically complex children, and 54% in children with inflammatory bowel disease (P = .04). FMT via intragastric delivery showed lower facility and professional charges by 85% and 78% compared with delivery via colonoscopy and radiology-placed nasoduodenal tube, respectively. The use of stool derived from a donor stool bank decreased charges by 49% compared with charges associated with the use of a donor who was a relative. CONCLUSION: A nurse-led intragastric FMT procedure using stool derived from a donor stool bank is a relatively inexpensive and efficacious treatment for recurrent CDI in children. Intragastric FMT success in children was attenuated by the presence of underlying disease, particularly inflammatory bowel disease.
Authors: Joseph A Spinner; Claire E Bocchini; Ruth A Luna; Santosh Thapa; Miriam A Balderas; Susan W Denfield; William J Dreyer; Dorottya Nagy-Szakal; Faith D Ihekweazu; James Versalovic; Tor Savidge; Richard Kellermayer Journal: Pediatr Transplant Date: 2019-10-16
Authors: 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 Lewis; Ashley 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 Journal: Clin Gastroenterol Hepatol Date: 2019-04-19 Impact factor: 11.382
Authors: Madeleine Morrissette; Norman Pitt; Antonio González; Philip Strandwitz; Mariaelena Caboni; Alison W Rebman; Rob Knight; Anthony D'Onofrio; John N Aucott; Mark J Soloski; Kim Lewis Journal: mBio Date: 2020-09-29 Impact factor: 7.867