Maribeth R Nicholson1, Paul D Mitchell2, Erin Alexander3, Sonia Ballal2, Mark Bartlett3, Penny Becker4, Zev Davidovics4, Michael Docktor2, Michael Dole1, Grace Felix5, Jonathan Gisser6, Suchitra K Hourigan7, M Kyle Jensen8, Jess L Kaplan9, Judith Kelsen10, Melissa Kennedy10, Sahil Khanna3, Elizabeth Knackstedt8, McKenzie Leier2, Jeffery Lewis11, Ashley Lodarek2, Sonia Michail12, Maria Oliva-Hemker5, Tiffany Patton13, Karen Queliza14, George H Russell15, Namita Singh16, Aliza Solomon17, David L Suskind18, Steven Werlin19, Richard Kellermayer14, Stacy A Kahn20. 1. Vanderbilt University Medical Center, Nashville, Tennessee. 2. Boston Children's Hospital, Boston, Massachusetts. 3. Mayo Clinic, Rochester, Minnesota. 4. Connecticut Children's Medical Center, Hartford, Connecticut. 5. Johns Hopkins Children's Center, Baltimore, Maryland. 6. Nationwide Children's Hospital, Columbus, Ohio. 7. Johns Hopkins Children's Center, Baltimore, Maryland; Pediatric Specialists of Virginia, Fairfax, Virginia. 8. Primary Children's Hospital at University of Utah, Salt Lake City, Utah. 9. MassGeneral Hospital for Children, Boston, Massachusetts. 10. Children's Hospital of Philadelphia, Philadelphia, Pennsylvania. 11. Children's Center for Digestive Healthcare at Children's Healthcare of Atlanta, Atlanta, Georgia. 12. University of Southern California, Children's Hospital of Los Angeles, Los Angeles, California. 13. University of Chicago, Chicago, Illinois. 14. Baylor College of Medicine, Texas Children's Hospital, Children's Nutrition and Research Center, Houston, Texas. 15. Barbara Bush Children's Hospital, Portland, Maine. 16. Cedars Sinai Medical Center, Los Angeles, California. 17. Weill Cornell Medicine, New York, New York. 18. Seattle Children's Hospital and the University of Washington, Seattle, Washington. 19. Medical College of Wisconsin, Milwaukee, Wisconsin. 20. Boston Children's Hospital, Boston, Massachusetts. Electronic address: Stacy.Kahn@childrens.harvard.edu.
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.
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.
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