Fecal Transplant in Children With Clostridioides difficile Gives Sustained Reduction in Antimicrobial Resistance and Potential Pathogen Burden

Hourigan, Suchitra K.; Ahn, Michelle; Gibson, Keylie M.; Pérez‐Losada, Marcos; Felix, Grace; Weidner, Melissa; Leibowitz, Ian; Niederhuber, John E.; Sears, Cynthia L.; Crandall, Keith A.; Oliva‐Hemker, Maria

doi:10.1093/ofid/ofz379

Cited by 33 publications

(48 citation statements)

References 63 publications

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“…After FMT, the levels of F. prausnitzii were significantly increased at week 4 compared with the baseline, but remained lower compared with healthy donors. F. prausnitzii abundance is strongly correlated with the diagnostic and therapeutic effectiveness of FMT (54).…”

Section: Discussionmentioning

confidence: 99%

Fecal microbiota transplantation ameliorates active ulcerative colitis

Chen

Huang

et al. 2020

Exp Ther Med

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Ulcerative colitis (UC) is a complex chronic pathological condition of the gut in which microbiota targeted treatment, such as fecal microbiota transplantation (FMT), has shown an encouraging effect. The aim of the present study was to investigate the efficacy and safety of FMT in patients with mild or moderate UC. A single-center, open-label study was designed, including 47 patients with mild or moderate active UC who received three treatments of fresh FMT via colonic transendoscopic enteral tubing within 1 week. The inflammatory bowel disease questionnaire, partial Mayo scores, colonoscopy, erythrocyte sedimentation rate, C-reactive protein level and procalcitoin values were used to assess the efficacy of FMT and alteration in gut microbiota was detected by 16S ribosomal RNA-sequencing. Before FMT, microbiota Faecalibacterium prausnitzii (F. prausnitzii) levels were significantly decreased in patients with UC compared with healthy donors (P<0.01). At 4 weeks post-FMT, F. prausnitzii levels were significantly increased (P<0.05), and the Mayo score was significantly decreased (1.91±1.07 at baseline vs. 4.02±1.47 at week 4; P<0.001) in patients with UC compared with healthy donors. Steroid-free clinical responses were reported in 37 patients (84.1%), and steroid-free clinical remission was achieved in 31 patients (70.5%) at week 4 post-FMT, however, steroid-free remission was not achieved in any patient. No adverse events were reported in 41 (93.2%) patients after FMT or during the 12-week follow-up. Shannon's diversity index and Chao1 estimator were also improved in patients with UC receiving FMT. In conclusion, the results of the present study suggested that FMT resulted in clinical remission in patients with mild to moderate UC, and that the remission may be associated with significant alterations to the intestinal microbiota of patients with UC. Furthermore, F. prausnitzii may serve as a diagnostic and therapeutic biomarker for the use of FMT in UC.

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Section: Discussionmentioning

confidence: 99%

Fecal microbiota transplantation ameliorates active ulcerative colitis

Chen

Huang

et al. 2020

Exp Ther Med

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“…Solving such technical challenges could help us to understand better the role of bacteriophages in microbiome ecology. This is therapeutically important: bacteriophage transfer during FMT and abiotic FMT was associated with a positive outcome in patients with recurrent C. difficile infection [74][75][76], highlighting the complex interkingdom interactions within the microbiota community. down to specific microbes, such as when a specific commensal belonging to the Bifidobacterium genus promotes antitumor immunity in mice [24].…”

Section: Oncogenic Viruses and The Microbiomementioning

confidence: 99%

The Cancer Microbiome: Distinguishing Direct and Indirect Effects Requires a Systemic View

et al. 2020

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The collection of microbes that live in and on the human bodythe human microbiomecan impact on cancer initiation, progression, and response to therapy, including cancer immunotherapy. The mechanisms by which microbiomes impact on cancers can yield new diagnostics and treatments, but much remains unknown. The interactions between microbes, diet, host factors, drugs, and cellcell interactions within the cancer itself likely involve intricate feedbacks, and no single component can explain all the behavior of the system. Understanding the role of host-associated microbial communities in cancer systems will require a multidisciplinary approach combining microbial ecology, immunology, cancer cell biology, and computational biologya systems biology approach.

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“…A meta-analysis including both adults and children patients did not demonstrate any significant differences in outcomes when comparing FMT for rCDI via colonoscopy versus the NG tube [45]. In a multicentre study, FMT using colonoscopy was found to be significantly more effective than FMT delivered using other routes in children [46].…”

Section: Recurrences and Faecal Microbiota Transplant (Fmt)mentioning

confidence: 88%

“…Table 3 summarizes antimicrobial treatment suggested for recurrent CDI in the paediatric population [19]. Good clinical response with FMT has been observed in adults with refractory or recurrent CDI with few reports of adverse events [44][45][46]. At present, data examining the effectiveness of FMT for children are lacking.…”

Section: Recurrences and Faecal Microbiota Transplant (Fmt)mentioning

confidence: 99%

“…Thus, recommendations regarding the therapy in multiple recurrent CDIs in paediatric age should be guided primarily by evidence from adult studies. As recently described, FMT is the most effective therapeutic approach against recurrent CDI (rCDI) and has become a standard in therapeutic algorithms, despite its unknown long-term consequences [44][45][46].…”

Section: Recurrences and Faecal Microbiota Transplant (Fmt)mentioning

confidence: 99%

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Updated Management Guidelines for Clostridioides difficile in Paediatrics

et al. 2020

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Clostridioides difficile, formerly known as Clostridium difficile, causes infections (CDI) varying from self-limited diarrhoea to severe conditions, including toxic megacolon and bowel perforation. For this reason, a prompt diagnosis is fundamental to early treatment and the prevention of transmission. The aim of this article is to review diagnostic laboratory methods that are now available to detect C. difficile and to discuss the most recent recommendations on CDI treatment in children. Currently, there is no consensus on the best method for detecting C. difficile. Indeed, none of the available diagnostics possess at the same time high sensitivity and specificity, low cost and rapid turnaround times. Appropriate therapy is targeted according to age, severity and recurrence of the episode of infection, and the recent availability of new antibiotics opens new opportunities. De-escalation of antibiotics that are directly associated with CDI remains a priority and the cautious use of probiotics is recommended. Vancomycin represents the first-line therapy for CDI, although in children metronidazole can still be used as a first-line drug. Fidaxomicin is a new treatment option with equivalent initial response rates as vancomycin but lower relapse rates of CDI. Faecal microbiota transplantation should be considered for patients with multiple recurrences of CDI. Monoclonal antibodies and vaccines seem to represent a future perspective against CDI. However, only further studies will permit us to understand whether these new approaches could be effective in therapy and prevention of CDI in paediatric populations.

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Fecal Transplant in Children With Clostridioides difficile Gives Sustained Reduction in Antimicrobial Resistance and Potential Pathogen Burden

Cited by 33 publications

References 63 publications

Fecal microbiota transplantation ameliorates active ulcerative colitis

Fecal microbiota transplantation ameliorates active ulcerative colitis

The Cancer Microbiome: Distinguishing Direct and Indirect Effects Requires a Systemic View

Updated Management Guidelines for Clostridioides difficile in Paediatrics

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