Fecal Microbiota Transplantation Commonly Failed in Children With Co-Morbidities

Authors

Richard Kellermayer
Qinglong Wu
Dorottya Nagy-Szakal
Karen Queliza
Faith D Ihekweazu
Claire E Bocchini
Abria R Magee
Numan Oezguen
Jennifer K Spinler
Emily B Hollister
Robert J Shulman
James Versalovic
Ruth Ann Luna
Tor C Savidge

Publication Date

2-1-2022

Journal

Journal of Pediatric Gastroenterology and Nutrition

DOI

10.1097/MPG.0000000000003336

PMID

34724447

PMCID

PMC8799498

PubMedCentral® Posted Date

2-1-2023

PubMedCentral® Full Text Version

Author MSS

Published Open-Access

yes

Keywords

Child, Clostridioides difficile, Clostridium Infections, Fecal Microbiota Transplantation, Feces, Humans, Morbidity, Prospective Studies, RNA, Ribosomal, 16S, Recurrence, Treatment Outcome, pediatric fecal transplant, Clostridioides difficile, inflammatory bowel disease, microbiome

Abstract

OBJECTIVES: Fecal microbiota transplantation (FMT) is arguably the most effective treatment for recurrent Clostridioides difficile infection (rCDI). Clinical reports on pediatric FMT have not systematically evaluated microbiome restoration in patients with co-morbidities. Here, we determined whether FMT recipient age and underlying co-morbidity influenced clinical outcomes and microbiome restoration when treated from shared fecal donor sources.

METHODS: Eighteen rCDI patients participating in a single-center, open-label prospective cohort study received fecal preparation from a self-designated (single case) or two universal donors. Twelve age-matched healthy children and four pediatric ulcerative colitis (UC) cases from an independent serial FMT trial, but with a shared fecal donor were examined as controls for microbiome restoration using 16S rRNA gene sequencing of longitudinal fecal specimens.

RESULTS: FMT was significantly more effective in rCDI recipients without underlying chronic co-morbidities where fecal microbiome composition in post-transplant responders was restored to levels of healthy children. Microbiome reconstitution was not associated with symptomatic resolution in some rCDI patients who had co-morbidities. Significant elevation in Bacteroidaceae, Bifidobacteriaceae, Lachnospiraceae, Ruminococcaceae, and Erysipelotrichaceae was consistently observed in pediatric rCDI responders, while Enterobacteriaceae decreased, correlating with augmented complex carbohydrate degradation capacity.

CONCLUSION: Recipient background disease was a significant risk factor influencing FMT outcomes. Special attention should be taken when considering FMT for pediatric rCDI patients with underlying co-morbidities.