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Updated: Oct 13, 2025
Fecal Microbiota Transplantation via Colonoscopy for Recurrent C. difficile Infection
Published on: December 8, 2014
Efficacy and Outcomes of Faecal Microbiota Transplantation for Recurrent Clostridioides difficile Infection in
Maribeth R Nicholson1, Erin Alexander2, Sonia Ballal3
1Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA.
Insights
Faecal microbiota transplantation (FMT) is effective for recurrent Clostridioides difficile infection (rCDI) in children with inflammatory bowel disease (IBD). Success rates were similar to children without IBD, but active IBD may impact outcomes.
Area of Science:
- Pediatric Gastroenterology
- Infectious Diseases
- Microbiome Research
Background:
- Recurrent Clostridioides difficile infection (rCDI) disproportionately affects children with inflammatory bowel disease (IBD).
- Faecal microbiota transplantation (FMT) shows efficacy in adult IBD patients, but its outcomes in pediatric IBD are less understood.
Purpose of the Study:
- To compare the efficacy of FMT for rCDI in children with and without IBD.
- To identify predictors of successful FMT and evaluate IBD-specific outcomes in pediatric IBD patients undergoing FMT.
Main Methods:
- Retrospective review of FMT cases from 20 US pediatric centers (March 2012-March 2020).
- Comparison of FMT efficacy between pediatric patients with and without IBD.
- Analysis of factors influencing FMT success and safety in pediatric IBD patients.
Main Results:
- FMT success rates for rCDI were similar in children with IBD (76%) and without IBD (81%).
- Predictors of successful FMT in pediatric IBD included fresh stool, absence of diarrhea pre-FMT, and shorter time from rCDI diagnosis to FMT.
- Children with failed FMT were more likely to have active IBD post-treatment, with 13% experiencing IBD-related hospitalizations.
Conclusions:
- FMT efficacy for rCDI in children with IBD is comparable to that in non-IBD children.
- Active inflammation in IBD may be a factor contributing to FMT failure in pediatric patients.
Background:
Children with inflammatory bowel disease [IBD] are disproportionally affected by recurrent Clostridioides difficile infection [rCDI]. Although faecal microbiota transplantation [FMT] has been used with good efficacy in adults with IBD, little is known about outcomes associated with FMT in paediatric IBD.
Methods:
We performed a retrospective review of FMT at 20 paediatric centres in the USA from March 2012 to March 2020. Children with and without IBD were compared with determined differences in the efficacy of FMT for rCDI. In addition, children with IBD with and without a successful outcome were compared with determined predictors of success. Safety data and IBD-specific outcomes were obtained.
Results:
A total of 396 paediatric patients, including 148 with IBD, were included. Children with IBD were no less likely to have a successful first FMT then the non-IBD affected cohort [76% vs 81%, p = 0.17]. Among children with IBD, patients were more likely to have a successful FMT if they received FMT with fresh stool [p = 0.03], were without diarrhoea prior to FMT [p = 0.03], or had a shorter time from rCDI diagnosis until FMT [p = 0.04]. Children with a failed FMT were more likely to have clinically active IBD post-FMT [p = 0.002] and 19 [13%] patients had an IBD-related hospitalisation in the 3-month follow-up.
Conclusions:
Based on the findings from this large US multicentre cohort, the efficacy of FMT for the treatment of rCDI did not differ in children with IBD. Failed FMT among children with IBD was possibly related to the presence of clinically active IBD.
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