Study data published in the Journal of Pediatric Gastroenterology and Nutrition identified underlying comorbidities as a significant risk factor for fecal microbiota transplantation (FMT) failure in children with recurrent Clostridioides difficile (C difficile) infection (rCDI).
FMT is commonly used for the treatment of rCDI, though its efficacy in children with comorbidities is relatively unknown. To inform this gap, investigators conducted a single-center, open-label, prospective study of children with rCDI who underwent FMT at the Baylor College of Medicine between 2013 and 2015.
Twelve age-matched healthy children and 4 children with ulcerative colitis (UC) from a separate FMT trial were considered the control group. All participants received FMTs from the same 2 donors. Pre- and post-transplant 16S rRNA amplicon sequencing was performed on fecal samples to evaluate microbiome restoration. Clinical outcomes of interest included symptomatic resolution in the 2 months following FMT and C difficile recurrence.
Of the 18 patients with rCDI, 9 (50%) had underlying gastrointestinal disease. Mean age at FMT was 9.3 years and 55.6% were boys. The success of FMT differed significantly between patients with and without underlying chronic conditions (P =.009). Specifically, just 20% of children with underlying inflammatory bowel disease (IBD) showed response to FMT, compared against 100% of children without underlying disease (P =.005). Patients with other complicated conditions also experienced diminished FMT efficacy, though the association was not significant.
Independent of fecal donor source, children with clinical response to FMT experienced microbiome restoration to the levels of healthy children. Elevation in the abundance of Bacteroidaceae, Bifidobacteriaceae, Lachnospiraceae, Ruminococcaceae, and Erysipelotrichaceae were consistently observed in FMT responders, while Enterobacteriaceae abundance decreased.
In patients who did not respond to FMT, microbiome changes were less substantial, though they occurred along similar axes. Specifically, decolonization of Enterobacteriaceae and increased abundance of Bifidobacteriaceae were observed in nonresponders compared with baseline levels. Improvements in the microbiome did not appear to correlate with clinical response in nonresponders. However, among patients who experienced clinical response, microbiome reconstitution was in agreement with FMT outcomes.
Study limitations include the single center design and small study cohort. Further research is necessary to better explore FMT outcomes in pediatric patients with complex medical histories.
“Recipient background disease was a significant risk factor influencing FMT outcomes,” investigators wrote. “Special attention should be taken when considering FMT for pediatric rCDI patients with underlying co-morbidities.”
Disclosure: Several study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
Kellermayer R, Wu Q, Nagy-Szakal D, et al. Fecal microbiota transplantation commonly failed in children with co-morbidities. J Pediatr Gastroenterol Nutr. 2022;74(2):227-235. doi: 10.1097/MPG.0000000000003336
This article originally appeared on Gastroenterology Advisor