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Analysis of Treatment Outcomes for Recurrent Clostridium difficile Infections and Fecal Microbiota Transplantation in a Pediatric Hospital

Aldrich, Aileen M., MD*; Argo, Taylor, MD; Koehler, Tracy J., PhD; Olivero, Rosemary, MD§

The Pediatric Infectious Disease Journal: January 2019 - Volume 38 - Issue 1 - p 32–36
doi: 10.1097/INF.0000000000002053
Original Studies
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Background: Clostridium difficile infection (CDI) is one of the most common nosocomial infections in the United States, with an increasing incidence in children. Approximately 20% of pediatric patients develop recurrent infections. It’s imperative to further analyze the incidence of recurrent CDI in the pediatric population and determine the most effective treatments. The primary goal of this study is to characterize children with recurrent CDI at our institution, including both hospital-acquired CDI (HA-CDI) and community-acquired CDI (CA-CDI) cases, summarize the various treatments utilized, including fecal microbiota transplant (FMT) and compare their success rates.

Methods: A retrospective cohort study of pediatric patients 1–21 years of age treated for CDI at a single institution from January 2010 to December 2014 was performed.

Results: There were 175 subjects with 215 separate episodes of CDI. Oral metronidazole was the most common initial treatment (145/207, 70%) followed by oral vancomycin (30/207, 15%), with recurrence rates of 30% (42/145) and 37% (11/30), respectively. Twenty-nine percent (63/215) of all initial CDI cases had at least 1 documented recurrence. Using multivariate analysis, subjects with HA-CDI were 2.6 times less likely to recur than those with CA-CDI (odds ratio: 0.39; 95% confidence interval: 0.18–0.85; P = 0.018). The overall success rate for FMT at our institution was 10/12 (83%).

Conclusions: Our data show that cases of HA-CDI were less likely to recur compared with CA-CDI. Although currently reserved for multiply-recurrent cases, FMT was highly successful in our small cohort. More studies on FMT should be conducted to further evaluate its usefulness in the treatment of recurrent CDI in children.

From the *Spectrum Health/Michigan State University/Helen DeVos Children’s Hospital Pediatric Residency Program

Michigan State College of Human Medicine

Spectrum Health, Research, Graduate Medical Education

§Section of Pediatric Infectious Diseases, Helen DeVos Children’s Hospital of Spectrum Health, Grand Rapids, Michigan; and Department of Pediatrics and Human Development, College of Human Medicine, Michigan State University, East Lansing, Michigan.

Accepted for publication March 8, 2018.

The authors have no funding or conflicts of interest to disclose.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (www.pidj.com).

The authors have no funding or conflicts of interest to disclose.

Address for correspondence: Aileen M. Aldrich, MD, Division of Pediatric Infectious Diseases, Children’s Hospital & Medical Center, 8200 Dodge Street, Omaha, NE 68114. E-mail: aileen.aldrich@unmc.edu or Rosemary Olivero, MD, Section of Pediatric Infectious Diseases, Helen DeVos Children’s Hospital, 35 Michigan St NE, MC 177, Grand Rapids, MI 49503. E-mail: rosemary.olivero@helendevoschildrens.org.

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