168 Microbiome Changes Associated With Sustained Eradication of Clostridium difficile After Fecal Microbiota Transplantation in Children With and Without Inflammatory Bowel Disease

Fecal microbiota transplantation in children: a brief review

“…Microbiome changes have been reported in a 20-mo-old boy (28), with decreased diversity of the microbiome prior to FMT, with a relative abundance of Proteobacteria, with increased diversity after FMT with increasing Bacteroidetes; these are similar changes to those previously described in adults (39,42). Additionally, in a case series of older children increased microbiome diversity after FMT for CDI appears to be sustained in those without IBD, however at 6 mo decreases to pre-FMT baseline in those with IBD, suggesting IBD hostrelated mechanisms may modify fecal microbiome diversity (29).…”

“…In small pediatric case series of up to 10 patients, pediatric case reports and series with both adults and children (25)(26)(27)(28)(29)(30)(31)(32)(33), the effectiveness of FMT was high, with the larger pediatric case series reporting a 90-100% (25)(26)(27)29) success rate in treating recurrent CDI ( Table 1). Success in pediatric patients has been reported with delivery of FMT to the upper gastrointestinal tract using nasogastric or transpyloric tubes or to…”

“…Children with underlying IBD have successfully received FMT for recurrent CDI (25)(26)(27)29) without reported worsening of their IBD symptoms. Many of these IBD patients, and other reported children were immunosuppressed at the time of FMT (25,29,33).…”

“…Many of these IBD patients, and other reported children were immunosuppressed at the time of FMT (25,29,33). Of note, while children with IBD do have an increased risk of recurrent CDI infection, patients with IBD who are C. difficile positive must be selected carefully for FMT, as there is a high rate of C. difficile carriage in this population and so symptoms may be due to IBD as oppose to CDI (36).…”

Epidemiology, Diagnosis, and Management of Clostridium difficile Infection in Patients with Inflammatory Bowel Disease

“…Initial case reports on use of FMT for IBD outside the context of recurrent CDI were encouraging for treatment of UC (132–135). While patients without IBD have fecal microbial diversity that stably mimics the donor stool following FMT, by six months post-FMT, patients with IBD have stool microbiota that returns to the pre-FMT level of diversity, suggesting host-related mechanisms that modify the microbiota (136). Subsequent reports have raised some concerns, however.…”