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Fecal Microbiota Transplantation via Colonoscopy for Recurrent C. difficile Infection
Published on: December 8, 2014
Clostridium difficile: A Frequent Infection in Children After Intestinal Transplantation
Rémi Duclaux-Loras1, Julien Berthiller2,3, Agnès Ferroni1
1Hôpital Necker-Enfants Malades Assistance Publique-Hôpitaux de Paris, Department of Pediatric Gastroenterology, Hepatology and Nutrition, Université Paris Descartes - Sorbonne Paris Cité, Paris, France.
Insights
Clostridium difficile infection (CDI) is common in children after intestinal transplantation (ITx), often causing mild symptoms. Standard antibiotic treatments effectively manage CDI, and graft rejection is rare.
Area of Science:
- Gastroenterology
- Pediatric Surgery
- Infectious Diseases
Background:
- Organ transplantation (Tx) increases the risk of Clostridium difficile infection (CDI).
- Limited data exist on CDI impact and rejection induction after intestinal transplantation (ITx).
Purpose of the Study:
- To evaluate the incidence, clinical presentation, and outcomes of CDI in pediatric ITx recipients.
- To assess the relationship between CDI and graft rejection in this population.
Main Methods:
- Retrospective analysis of pediatric patients undergoing ITx with at least one year of graft survival.
- Inclusion of all samples positive for Clostridium difficile (CD) and its toxin.
Main Results:
- 39% of 57 ITx recipients developed culture-proven CDI.
- Most cases were symptomatic (diarrhea, bloody stools) but generally mild to moderate.
- Standard antibiotic therapy was effective; graft rejection was a rare complication, occurring in 3 patients, with 2 cases concomitant with CDI.
Conclusions:
- CDI is more prevalent in pediatric ITx recipients than in other organ transplant recipients.
- CDI in this cohort is typically symptomatic but not severe, and standard antibiotics are effective.
- Induction of graft rejection by CDI is an infrequent occurrence.
Background:
Organ transplantation (Tx) is a risk factor for Clostridium difficile infection (CDI). After intestinal transplantation (ITx), few data are available on the impact of this graft infection and the possible induction of rejection.
Methods:
We included retrospectively all children after ITx in our unit, with at least 1 year of graft survival. All samples positive for Clostridium difficile (CD) and its toxin were considered.
Results:
Among the 57 ITx recipients (60 Txs), 22 children (39%) developed culture-proven CDI, 12 after isolated small bowel Tx, 9 after liver-small bowel Tx, and 1 after multivisceral Tx. Twenty patients had diarrhea, 8 bloody stools, 4 fever, and 1 hypothermia. Nine were hospitalized for an average of 6.5 days (2-20) and 4 with severe dehydration. Nine (40%) had received antibiotics for an average of 19 days (7-60) before CDI. Two patients were asymptomatic. CDI was treated with metronidazole in 12 children, vancomycin in 6, and both in 3. Three children presented mild-to-severe rejections. Two patients presented concomitantly CDI and rejection. The third patient presented a rejection with severe complications 4 years after CDI. Recurrence of toxinogenic CD was observed in 9 children, in 7 associated with clinical symptoms. During the last follow-up, the stool number was the same as before CDI except for 1 patient with ongoing infection.
Conclusions:
CDI is more prevalent in children after ITx compared with other organ Tx; it is most often symptomatic but mildly or moderately severe. Standard antibiotics efficiently control the symptoms. Induction of rejection is a rare event.
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