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Updated: Oct 14, 2025
Fecal Microbiota Transplantation via Colonoscopy for Recurrent C. difficile Infection
Published on: December 8, 2014
Fecal Microbiota Transplantation Commonly Failed in Children With Co-Morbidities
Richard Kellermayer1,2, Qinglong Wu3,4, Dorottya Nagy-Szakal1
1Gastroenterology, Hepatology & Nutrition, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital.
Objectives:
Fecal microbiota transplantation (FMT) is arguably the most effective treatment for recurrent Clostridioides difficile infection (rCDI). Clinical reports on pediatric FMT have not systematically evaluated microbiome restoration in patients with co-morbidities. Here, we determined whether FMT recipient age and underlying co-morbidity influenced clinical outcomes and microbiome restoration when treated from shared fecal donor sources.
Methods:
Eighteen rCDI patients participating in a single-center, open-label prospective cohort study received fecal preparation from a self-designated (single case) or two universal donors. Twelve age-matched healthy children and four pediatric ulcerative colitis (UC) cases from an independent serial FMT trial, but with a shared fecal donor were examined as controls for microbiome restoration using 16S rRNA gene sequencing of longitudinal fecal specimens.
Results:
FMT was significantly more effective in rCDI recipients without underlying chronic co-morbidities where fecal microbiome composition in post-transplant responders was restored to levels of healthy children. Microbiome reconstitution was not associated with symptomatic resolution in some rCDI patients who had co-morbidities. Significant elevation in Bacteroidaceae, Bifidobacteriaceae, Lachnospiraceae, Ruminococcaceae, and Erysipelotrichaceae was consistently observed in pediatric rCDI responders, while Enterobacteriaceae decreased, correlating with augmented complex carbohydrate degradation capacity.
Conclusion:
Recipient background disease was a significant risk factor influencing FMT outcomes. Special attention should be taken when considering FMT for pediatric rCDI patients with underlying co-morbidities.
Insights
Fecal microbiota transplantation (FMT) effectively treats recurrent Clostridioides difficile infection (rCDI) in children without comorbidities. However, underlying health issues in pediatric rCDI patients receiving FMT can impact treatment success and microbiome restoration.
Area of Science:
- Microbiology
- Gastroenterology
- Pediatric Medicine
Background:
- Recurrent Clostridioides difficile infection (rCDI) poses a significant challenge in pediatric populations.
- Fecal microbiota transplantation (FMT) is a highly effective treatment for rCDI, but its efficacy in children with co-morbidities requires further investigation.
- Systematic evaluation of microbiome restoration in pediatric FMT recipients with co-existing conditions is lacking.
Purpose of the Study:
- To determine if recipient age and underlying co-morbidities influence clinical outcomes and microbiome restoration in pediatric patients undergoing FMT for rCDI.
- To compare microbiome restoration in pediatric FMT recipients with healthy children and pediatric ulcerative colitis (UC) cases using shared fecal donors.
- To identify factors affecting FMT success in pediatric rCDI.
Main Methods:
- A single-center, open-label prospective cohort study involving 18 pediatric rCDI patients receiving FMT.
- Fecal specimens were collected longitudinally for microbiome analysis using 16S rRNA gene sequencing.
- Comparison with 12 healthy children and 4 pediatric UC cases from a separate FMT trial utilizing shared fecal donors.
Main Results:
- FMT demonstrated significantly higher efficacy in pediatric rCDI recipients without chronic co-morbidities.
- Microbiome composition in responders without co-morbidities was restored to levels observed in healthy children.
- Microbiome reconstitution did not consistently correlate with symptomatic resolution in pediatric rCDI patients with co-morbidities.
- Specific bacterial families (Bacteroidaceae, Bifidobacteriaceae, Lachnospiraceae, Ruminococcaceae, Erysipelotrichaceae) increased, while Enterobacteriaceae decreased in pediatric rCDI responders.
Conclusions:
- Underlying co-morbidities in pediatric rCDI patients are a significant risk factor influencing FMT outcomes.
- Careful consideration is warranted when implementing FMT for pediatric rCDI patients with co-existing health conditions.
- Further research is needed to optimize FMT strategies for pediatric rCDI patients with co-morbidities.
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