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Fecal Microbiota Transplant for Recurrent Clostridium difficile Infection in Pediatric Inflammatory Bowel Disease

Cho, Stanley*; Spencer, Elizabeth*; Hirten, Robert; Grinspan, Ari; Dubinsky, Marla C.*

Journal of Pediatric Gastroenterology and Nutrition: March 2019 - Volume 68 - Issue 3 - p 343–347
doi: 10.1097/MPG.0000000000002172
Original Articles: Gastroenterology: Inflammatory Bowel Disease
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Objectives: Recurrent Clostridium difficile infection (RCDI) increases morbidity and mortality in patients with inflammatory bowel disease (IBD). Fecal microbiota transplant (FMT) is known to be very effective for RCDI in non-IBD patients with cure rates up to 91%. The same success rates of FMT have not been reported in patients with IBD with RCDI, and the data in pediatrics are limited. We aimed to determine the effectiveness of FMT for RCDI in established pediatric patients with IBD.

Methods: We performed a retrospective chart review of pediatric patients with IBD and RCDI (≥3 episodes) who underwent FMT via colonoscopy at a tertiary care IBD center. The primary outcome was the rate of RCDI within 60 days post-FMT. The secondary outcomes were recurrence rate by 6 months, rate of colectomy, and time to recurrence.

Results: Of the 8 eligible patients, 6 had ulcerative colitis, 1 had IBD-unspecified, and 1 had Crohn disease. Median (interquartile range) age was 13 (11–14) years. All patients were on vancomycin at FMT. Two patients (25%) had RCDI by 60 days post-FMT and another 3 patients had RCDI between 60 days and 6 months. The median time to recurrence was 101 (40–139) days. Two patients (25%) who developed recurrence went to colectomy after FMT.

Conclusions: With a cure rate of 75% at 60 days, FMT administered for the treatment of RCDI may be an effective treatment option in pediatric IBD. However, there appears to be a significant rate of late recurrence of C difficile infection after 60 days in these patients.

*Department of Pediatrics

Department of Medicine, Susan and Leonard Feinstein IBD Clinical Center, Icahn School of Medicine at Mount Sinai, New York, NY.

Address correspondence and reprint requests to Marla C. Dubinsky, MD, Icahn School of Medicine at Mount Sinai, 17 East 102nd St, 5th Floor, New York, NY 10029 (e-mail: Marla.Dubinsky@mssm.edu).

Received 30 June, 2018

Accepted 23 September, 2018

Dr Dubinsky provides consulting services for AbbVie, Janssen, Takeda, Pfizer, Celgene, and UCB. Dr Hirten serves as an advisory board member for Janssen and provides consulting services for Takeda. The remaining authors disclose no conflicts. There are no sources of funding to be disclosed.

© 2019 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,