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Updated: Aug 12, 2025
Fecal Microbiota Transplantation via Colonoscopy for Recurrent C. difficile Infection
Published on: December 8, 2014
Fecal Microbiota Transplantation for Clostridioides difficile Infection in Immunocompromised Pediatric Patients
Katie R Conover1, Imad Absah2, Sonia Ballal3
1From the Department of General Pediatrics, Vanderbilt University Medical Center, Nashville, TN.
Fecal microbiota transplantation (FMT) is effective for recurrent Clostridioides difficile infection (CDI) in immunocompromised (IC) children, with high success rates. While treatment-related serious adverse events (SAEs) occurred, they were manageable, underscoring the need for risk-benefit assessment.
Area of Science:
- Pediatric Gastroenterology
- Infectious Diseases
- Microbiome Research
Background:
- Recurrent Clostridioides difficile infection (CDI) poses a significant challenge, particularly in immunocompromised (IC) pediatric patients.
- Fecal microbiota transplantation (FMT) is an emerging therapy for recurrent CDI, but data in pediatric IC populations are limited.
Purpose of the Study:
- To evaluate the safety and effectiveness of FMT for treating recurrent CDI in pediatric immunocompromised (IC) patients.
- To assess the success rates and serious adverse events (SAEs) associated with FMT in this specific cohort.
Main Methods:
- A multicenter retrospective cohort study included 42 pediatric patients with recurrent CDI and an immunocompromising condition.
- Patients underwent FMT between March 2013 and April 2020, with a 12-week follow-up period.
- Data on patient characteristics, FMT procedures, efficacy, and adverse events were collected and analyzed.
Main Results:
- The overall success rate of FMT for recurrent CDI was 79% after the first transplant and 86% after one or more transplants.
- The primary etiologies of immunocompromise included solid organ transplantation (43%), malignancy (28%), and primary immunodeficiency (24%).
- Serious adverse events (SAEs) occurred in 31% of patients, with 9.5% considered likely treatment-related; all patients recovered fully, and no deaths or multidrug-resistant organism infections were reported.
Conclusions:
- FMT demonstrates a high success rate for recurrent CDI in pediatric immunocompromised patients, comparable to adult and immunocompetent populations.
- While FMT-related SAEs are possible (9.5%), they are generally manageable and warrant careful consideration of the risk-benefit profile.
- This study supports FMT as a viable therapeutic option for recurrent CDI in pediatric IC patients, highlighting the need for continued monitoring and research.
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