Fecal Microbiota Transplant for Recurrent Clostridium difficile Infection in Pediatric Inflammatory Bowel Disease

Abstract

Objectives: Recurrent Clostridium difficile infection (RCDI) increases morbidity and mortality in patients with inflammatory bowel disease (IBD). Fecal microbiota transplant (FMT) is known to be very effective for RCDI in non-IBD patients with cure rates up to 91%. The same success rates of FMT have not been reported in patients with IBD with RCDI, and the data in pediatrics are limited. We aimed to determine the effectiveness of FMT for RCDI in established pediatric patients with IBD. Methods: We performed a retrospective chart review of pediatric patients with IBD and RCDI (≥3 episodes) who underwent FMT via colonoscopy at a tertiary care IBD center. The primary outcome was the rate of RCDI within 60 days post-FMT. The secondary outcomes were recurrence rate by 6 months, rate of colectomy, and time to recurrence. Results: Of the 8 eligible patients, 6 had ulcerative colitis, 1 had IBD-unspecified, and 1 had Crohn disease. Median (interquartile range) age was 13 (11–14) years. All patients were on vancomycin at FMT. Two patients (25%) had RCDI by 60 days post-FMT and another 3 patients had RCDI between 60 days and 6 months. The median time to recurrence was 101 (40–139) days. Two patients (25%) who developed recurrence went to colectomy after FMT. Conclusions: With a cure rate of 75% at 60 days, FMT administered for the treatment of RCDI may be an effective treatment option in pediatric IBD. However, there appears to be a significant rate of late recurrence of C difficile infection after 60 days in these patients.

Australian consensus statements for the regulation, production and use of faecal microbiota transplantation in clinical practice

“…FMT was strongly recommended in recurrent CDI complicating IBD and repeated FMT may be necessary 125 127. The disease course of the underlying IBD may improve, remain static, or worsen following FMT and therefore requires close monitoring following treatment 128 129…”

Circulating Metabolites Originating from Gut Microbiota Control Endothelial Cell Function

“…Transplantation of fecal microbiota, which consists in the transfer of intestinal flora from a donor to the intestinal tract of a recipient, aims to increase the diversity of the gut microbiota and change its composition. While it has been successful in treating inflammatory bowel disease and Clostridium difficile infection [151,152], the risks of spreading unknown microorganisms to the recipient still remain [153]. We are in the early days of this new treatment, and only appropriately designed clinical trials and post-marketing surveillance will reveal its safety in the long term.…”

The role of faecal microbiota transplantation in the treatment of inflammatory bowel disease

“…In the largest cohort of 67 IBD patients co-infected with CDI, after FMT IBD disease activity was reported as improved in 25 (37%), no change in 20 (30%), and worse in 9 (13%) patients through a combination of clinical assessments and biomarkers of disease activity [ 12 • ]. Reassuringly, any potential disease worsening is usually transient and should not impact the decision to use FMT in this cohort [ 5 • , 11 , 12 • , 13 , 14 ].…”