Efficacy of Fecal Microbiota Transplantation for Clostridium difficile Infection in Children.
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
Author Information
Maribeth R Nicholson: Vanderbilt University Medical Center, Nashville, Tennessee.
Paul D Mitchell: Boston Children's Hospital, Boston, Massachusetts.
Erin Alexander: Mayo Clinic, Rochester, Minnesota.
Sonia Ballal: Boston Children's Hospital, Boston, Massachusetts.
Mark Bartlett: Mayo Clinic, Rochester, Minnesota.
Penny Becker: Connecticut Children's Medical Center, Hartford, Connecticut.
Zev Davidovics: Connecticut Children's Medical Center, Hartford, Connecticut.
Michael Docktor: Boston Children's Hospital, Boston, Massachusetts.
Michael Dole: Vanderbilt University Medical Center, Nashville, Tennessee.
Grace Felix: Johns Hopkins Children's Center, Baltimore, Maryland.
Jonathan Gisser: Nationwide Children's Hospital, Columbus, Ohio.
Suchitra K Hourigan: Johns Hopkins Children's Center, Baltimore, Maryland; Pediatric Specialists of Virginia, Fairfax, Virginia.
M Kyle Jensen: Primary Children's Hospital at University of Utah, Salt Lake City, Utah.
Jess L Kaplan: MassGeneral Hospital for Children, Boston, Massachusetts.
Judith Kelsen: Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Melissa Kennedy: Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Sahil Khanna: Mayo Clinic, Rochester, Minnesota.
Elizabeth Knackstedt: Primary Children's Hospital at University of Utah, Salt Lake City, Utah.
McKenzie Leier: Boston Children's Hospital, Boston, Massachusetts.
Jeffery Lewis: Children's Center for Digestive Healthcare at Children's Healthcare of Atlanta, Atlanta, Georgia.
Ashley Lodarek: Boston Children's Hospital, Boston, Massachusetts.
Sonia Michail: University of Southern California, Children's Hospital of Los Angeles, Los Angeles, California.
Maria Oliva-Hemker: Johns Hopkins Children's Center, Baltimore, Maryland.
Tiffany Patton: University of Chicago, Chicago, Illinois.
Karen Queliza: Baylor College of Medicine, Texas Children's Hospital, Children's Nutrition and Research Center, Houston, Texas.
George H Russell: Barbara Bush Children's Hospital, Portland, Maine.
Namita Singh: Cedars Sinai Medical Center, Los Angeles, California.
Aliza Solomon: Weill Cornell Medicine, New York, New York.
David L Suskind: Seattle Children's Hospital and the University of Washington, Seattle, Washington.
Steven Werlin: Medical College of Wisconsin, Milwaukee, Wisconsin.
Richard Kellermayer: Baylor College of Medicine, Texas Children's Hospital, Children's Nutrition and Research Center, Houston, Texas.
Stacy A Kahn: Boston Children's Hospital, Boston, Massachusetts. Electronic address: Stacy.Kahn@childrens.harvard.edu.
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.
