Maribeth R Nicholson1, Erin Alexander2, Sonia Ballal3, Zev Davidovics4, Michael Docktor3, Michael Dole1, Jonathan M Gisser5, Alka Goyal6, Suchitra K Hourigan7, M Kyle Jensen8, Jess L Kaplan9, Richard Kellermayer10, Judith R Kelsen11, Melissa A Kennedy11, Sahil Khanna2, Elizabeth D Knackstedt8, Jennifer Lentine12, Jeffery D Lewis13, Sonia Michail14, Paul D Mitchell3, Maria Oliva-Hemker15, Tiffany Patton16, Karen Queliza10, Sarah Sidhu15, Aliza B Solomon12, David L Suskind17, Madison Weatherly3, Steven Werlin18, Edwin F de Zoeten19, Stacy A Kahn3. 1. Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA. 2. Department of Pediatrics, Mayo Clinic, Rochester, MN, USA. 3. Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA. 4. Department of Pediatrics, Connecticut Children's Medical Center, Hartford, CT, USA. 5. Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA. 6. Department of Pediatrics, Children's Mercy Hospital, Kansas City, MO, USA. 7. Department of Pediatrics, Pediatric Specialists of Virginia, Fairfax, VA, USA. 8. Department of Pediatrics, University of Utah Department of Pediatrics, Salt Lake City, UT, USA. 9. Department of Pediatrics, MassGeneral Hospital for Children, Boston, MA, USA. 10. Baylor College of Medicine, Texas Children's Hospital, USDA Children's Nutrition and Research Center, Houston, TX, USA. 11. Department of Pediatrics, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA. 12. Department of Pediatrics, Weill Cornell Medicine, New York, NY, USA. 13. Children's Center for Digestive Healthcare at Children's Healthcare of Atlanta, Atlanta, GA, USA. 14. Department of Pediatrics, University of Southern California Children's Hospital of Los Angeles, Los Angeles, CA, USA. 15. Johns Hopkins University School of Medicine, Johns Hopkins Children's Center, Baltimore, MD, USA. 16. Department of Pediatrics, University of Chicago, Comer Children's Hospital, Chicago, IL, USA. 17. Department of Pediatrics, Seattle Children's Hospital and the University of Washington, Seattle, WA, USA. 18. Department of Pediatrics, Medical College of Wisconsin and Children's Wisconsin, Milwaukee, WI, USA. 19. Department of Pediatrics, Children's Hospital Colorado, Aurora, CO, USA.
Abstract
BACKGROUND: Children with inflammatory bowel disease [IBD] are disproportionally affected by recurrent Clostridioides difficile infection [rCDI]. Although faecal microbiota transplantation [FMT] has been used with good efficacy in adults with IBD, little is known about outcomes associated with FMT in paediatric IBD. METHODS: We performed a retrospective review of FMT at 20 paediatric centres in the USA from March 2012 to March 2020. Children with and without IBD were compared with determined differences in the efficacy of FMT for rCDI. In addition, children with IBD with and without a successful outcome were compared with determined predictors of success. Safety data and IBD-specific outcomes were obtained. RESULTS: A total of 396 paediatric patients, including 148 with IBD, were included. Children with IBD were no less likely to have a successful first FMT then the non-IBD affected cohort [76% vs 81%, p = 0.17]. Among children with IBD, patients were more likely to have a successful FMT if they received FMT with fresh stool [p = 0.03], were without diarrhoea prior to FMT [p = 0.03], or had a shorter time from rCDI diagnosis until FMT [p = 0.04]. Children with a failed FMT were more likely to have clinically active IBD post-FMT [p = 0.002] and 19 [13%] patients had an IBD-related hospitalisation in the 3-month follow-up. CONCLUSIONS: Based on the findings from this large US multicentre cohort, the efficacy of FMT for the treatment of rCDI did not differ in children with IBD. Failed FMT among children with IBD was possibly related to the presence of clinically active IBD.
BACKGROUND: Children with inflammatory bowel disease [IBD] are disproportionally affected by recurrent Clostridioides difficile infection [rCDI]. Although faecal microbiota transplantation [FMT] has been used with good efficacy in adults with IBD, little is known about outcomes associated with FMT in paediatric IBD. METHODS: We performed a retrospective review of FMT at 20 paediatric centres in the USA from March 2012 to March 2020. Children with and without IBD were compared with determined differences in the efficacy of FMT for rCDI. In addition, children with IBD with and without a successful outcome were compared with determined predictors of success. Safety data and IBD-specific outcomes were obtained. RESULTS: A total of 396 paediatric patients, including 148 with IBD, were included. Children with IBD were no less likely to have a successful first FMT then the non-IBD affected cohort [76% vs 81%, p = 0.17]. Among children with IBD, patients were more likely to have a successful FMT if they received FMT with fresh stool [p = 0.03], were without diarrhoea prior to FMT [p = 0.03], or had a shorter time from rCDI diagnosis until FMT [p = 0.04]. Children with a failed FMT were more likely to have clinically active IBD post-FMT [p = 0.002] and 19 [13%] patients had an IBD-related hospitalisation in the 3-month follow-up. CONCLUSIONS: Based on the findings from this large US multicentre cohort, the efficacy of FMT for the treatment of rCDI did not differ in children with IBD. Failed FMT among children with IBD was possibly related to the presence of clinically active IBD.
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