Clinical Efficacy and Microbiome Changes Following Fecal Microbiota Transplantation in Children With Recurrent Clostridium Difficile Infection

Abstract

Fecal microbiota transplantation (FMT) has been shown as an effective treatment for recurrent clostridium difficile infection (RCDI) in adults. In this study, we aim to evaluate the clinical efficacy of FMT in treating children with RCDI, and explore fecal microbiota changes during FMT treatment. A total of 11 RCDI subjects with a median age of 3.5 years were enrolled in this single-center prospective pilot study. All patients were cured (11/11, 100%) by FMT either through upper gastrointestinal tract route with a nasointestinal tube (13/16, 81.2%) or lower gastrointestinal tract route with a rectal tube (3/16, 18.8%). The cure rate of single FMT was 63.6% (7/11), and 4 (4/11, 36.4%) cases were performed with 2 or 3 times of FMT. Mild adverse events were reported in 4 children (4/11, 36.4%), including transient diarrhea, mild abdominal pain, transient fever and vomit. Gut microbiota composition analysis of 59 fecal samples collected from 34 participants (9 RCDI children, 9 donors and 16 health controls) showed that the alpha diversity was lower in pediatric RCDI patients before FMT than the healthy controls and donors, and fecal microbial community of pre-FMT samples (beta diversity) was apart from that of healthy controls and donors. No significant differences in alpha diversity, beta diversity or phylogenetic distance were detected between donors and healthy controls. Both the richness and diversity of gut microbiota were improved in the pediatric RCDI patients after FMT, and the bacteria community was shifted closer to the donor and healthy control group. Furthermore, FMT re-directed gut microbiome functions of pediatric RCDI toward a health state. Our results indicate that it is safe and tolerant to use FMT in treating pediatric RCDI. FMT shifted the gut microbiome composition and function in children with RCDI toward a healthy state.

Fecal Microbiota Transplantation Increases Colonic IL-25 and Dampens Tissue Inflammation in Patients with Recurrent Clostridioides difficile

“…Some notable taxa include the genera Escherichia /Shigella , Akkermansia , and Bacteroides , which had different abundances between pre- and post-FMT. Escherichia /Shigella was found to be more abundant prior to FMT, which agrees with previous studies ( 38 , 39 ). Akkermansia decreased after FMT, while Bacteroides was increased after FMT.…”

Fecal microbiota transplantation increases colonic IL-25 and dampens tissue inflammation in patients with recurrentClostridioides difficile

“…Some notable taxa include the genera Escherichia/Shigella, Akkermansia and Bacteroides, which had different abundances between pre and post FMT. Escherichia/Shigella was found to be more abundant prior to FMT, which agrees with previous studies (Ling, Liu et al 2014, Li, Gao et al 2018. Akkermansia decreased after FMT while Bacteroides was increased after FMT.…”

Factors Related to Outcomes of Fecal Microbiota Transplantation in Patients with Clostridioides difficile Infection

“…These results are in good agreement with those in previous studies. 25,26 In addition, there was a significant difference in the microbiome composition of pre-FMT stool between successful and failed cases. This implies that the composition of the stool microbiome might predict the outcome of FMT in patients with CDI.…”