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Fecal Microbiota Transplantation via Colonoscopy for Recurrent C. difficile Infection
Published on: December 8, 2014
Fecal Microbiota Transplant for Recurrent Clostridium difficile Infection in Pediatric Inflammatory Bowel Disease
Stanley Cho1, Elizabeth Spencer1, Robert Hirten2
1Department of Pediatrics.
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.
Insights
Fecal microbiota transplant (FMT) shows promise for treating recurrent Clostridium difficile infection (RCDI) in pediatric patients with inflammatory bowel disease (IBD). While effective short-term, late recurrences of RCDI were observed in a significant portion of patients.
Area of Science:
- Gastroenterology
- Microbiology
- Pediatric Inflammatory Bowel Disease
Background:
- Recurrent Clostridium difficile infection (RCDI) poses significant risks in inflammatory bowel disease (IBD) patients.
- Fecal microbiota transplant (FMT) is highly effective for RCDI in non-IBD populations.
- Limited pediatric data exists on FMT for RCDI in IBD.
Purpose of the Study:
- To evaluate the effectiveness of FMT for RCDI in pediatric IBD patients.
- To assess short-term and long-term RCDI recurrence rates after FMT.
- To determine colectomy rates and time to recurrence post-FMT.
Main Methods:
- Retrospective chart review of pediatric IBD patients with RCDI (≥3 episodes).
- FMT administered via colonoscopy at a tertiary care center.
- Primary outcome: RCDI rate within 60 days; secondary outcomes: recurrence by 6 months, colectomy, time to recurrence.
Main Results:
- 8 pediatric IBD patients (6 UC, 1 IBD-U, 1 CD) received FMT.
- 25% experienced RCDI within 60 days; an additional 37.5% recurred between 60 days and 6 months.
- Median time to recurrence was 101 days; 25% of recurrent cases led to colectomy.
Conclusions:
- FMT demonstrates a 75% cure rate for RCDI at 60 days in pediatric IBD patients.
- Late recurrence of C. difficile infection is a concern after 60 days.
- FMT may be a viable treatment option, but requires further investigation for long-term efficacy.
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