ABSTRACT
OBJECTIVES: We sought to evaluate the safety and effectiveness of fecal microbiota transplantation (FMT) for recurrent Clostridioides difficile infection (CDI) in pediatric immunocompromised (IC) patients. METHODS: This is a multicenter retrospective cohort study of pediatric participants who underwent FMT between March 2013 and April 2020 with 12-week follow-up. Pediatric patients were included if they met the definition of IC and were treated with FMT for an indication of recurrent CDI. We excluded patients over 18 years of age, those with incomplete records, insufficient follow-up, or not meeting study definition of IC. We also excluded those treated for Clostridioides difficile recurrence without meeting the study definition and those with inflammatory bowel disease without another immunocompromising condition. RESULTS: Of 59 pediatric patients identified at 9 centers, there were 42 who met inclusion and no exclusion criteria. Included patients had a median age of 6.7 years. Etiology of IC included: solid organ transplantation (18, 43%), malignancy (12, 28%), primary immunodeficiency (10, 24%), or other chronic conditions (2, 5%). Success rate was 79% after first FMT and 86% after 1 or more FMT. There were no statistically significant differences in patient characteristics or procedural components when patients with a failed FMT were compared to those with a successful FMT. There were 15 total serious adverse events (SAEs) in 13 out of 42 (31%) patients that occurred during the follow-up period; 4 (9.5%) of which were likely treatment-related. There were no deaths or infections with multidrug resistant organisms during follow-up and all patients with a SAE fully recovered. CONCLUSIONS: The success rate of FMT for recurrent CDI in this pediatric IC cohort is high and mirrors data for IC adults and immunocompetent children. FMT-related SAEs do occur (9.5%) and highlight the need for careful consideration of risk and benefit.
Subject(s)
Clostridioides difficile , Clostridium Infections , Adult , Humans , Child , Adolescent , Fecal Microbiota Transplantation/adverse effects , Retrospective Studies , Treatment Outcome , Recurrence , Clostridium Infections/therapyABSTRACT
We report the case of a 3-year-old male who developed recurrent Clostridium difficile infection after receiving an orthotopic heart transplant. Despite multiple courses of antibiotics, C. difficile infection was persistent and he underwent a fecal microbiota transplant. The patient responded with resolution of his diarrhea. However, within 2 months he developed severe mixed rejection with high circulating donor-specific antibodies and significant coronary vasculopathy. Organ dysfunction led to the need for re-transplantation. The patient's postoperative course has since been complicated by pneumatosis intestinalis and recurrent C. difficile infection.
Subject(s)
Allografts/blood supply , Clostridium Infections/therapy , Fecal Microbiota Transplantation/adverse effects , Graft Rejection/immunology , Heart Transplantation/adverse effects , Vascular Diseases/immunology , Allografts/immunology , Anti-Bacterial Agents/therapeutic use , Child, Preschool , Clostridioides difficile/isolation & purification , Clostridium Infections/microbiology , Coronary Vessels/immunology , Graft Rejection/surgery , Humans , Male , Myocardium/immunology , Recurrence , Reoperation , Vascular Diseases/surgerySubject(s)
Anti-Bacterial Agents/adverse effects , Drug Hypersensitivity Syndrome/diagnosis , Lymphohistiocytosis, Hemophagocytic/chemically induced , Osteomyelitis/microbiology , Piperacillin, Tazobactam Drug Combination/adverse effects , Anti-Bacterial Agents/therapeutic use , Antifungal Agents/therapeutic use , Candida albicans/drug effects , Candida albicans/isolation & purification , Drug Hypersensitivity Syndrome/pathology , Drug Hypersensitivity Syndrome/therapy , Eosinophilia/chemically induced , Eosinophilia/pathology , Fluconazole/therapeutic use , Humans , Lymphohistiocytosis, Hemophagocytic/pathology , Osteomyelitis/drug therapy , Piperacillin, Tazobactam Drug Combination/therapeutic use , Pseudomonas aeruginosa/drug effects , Pseudomonas aeruginosa/isolation & purification , Staphylococcus aureus/drug effects , Staphylococcus aureus/isolation & purification , beta-Lactamase Inhibitors/therapeutic useABSTRACT
Solid-organ transplantation in pediatrics can be a life-saving procedure, but it cannot be accomplished without risk of infection-related morbidity and mortality. Evaluation of the recipient during candidacy and donor during evaluation can assist with identification of risk. Further, risk of infection from the surgical procedure can be mitigated through careful planning and attention to infection prevention processes. Finally, early recognition of infection posttransplant can limit the impact of these events.