Fecal Microbiota Transplant for Recurrent Clostridium Difficile Infection in Pediatric Inflammatory Bowel Disease

Objectives: Recurrent Clostridium difficile infection (RCDI) increases morbidity and mortality in patients with inflammatory bowel disease (IBD). Fecal microbiota transplant (FMT) is known to be very effective for RCDI in non-IBD patients with cure rates up to 91%. The same success rates of FMT have not been reported in IBD patients with RCDI, and the data in pediatrics is limited. We aimed to determine the effectiveness of FMT for RCDI in established pediatric IBD patients. Methods: We performed a retrospective chart review of pediatric patients with IBD and RCDI (≥3 episodes) who underwent FMT via colonoscopy at a tertiary care IBD center. The primary outcome was the rate of RCDI within 60 days post-FMT. The secondary outcomes were recurrence rate by 6 months, rate of colectomy, and time to recurrence. Results: Of the 8 eligible patients, 6 had ulcerative colitis, 1 had IBD-unspecified, and 1 had Crohn's disease. Median [interquartile range] age was 13 [11–14] years. All patients were on vancomycin at FMT. Two patients (25%) had RCDI by 60 days post-FMT and another 3 patients had RCDI between 60 days and 6 months. The median time to recurrence was 101 [40–139] days. Two patients (25%) who developed recurrence went to colectomy after FMT. Conclusions: With a cure rate of 75% at 60 days, FMT administered for the treatment of RCDI may be an effective treatment option in pediatric IBD. However, there appears to be a significant rate of late recurrence of CDI after 60 days in these patients. Address correspondence and reprint requests to Marla C. Dubinsky, MD, Icahn School of Medicine at Mount Sinai, New York, 17 East 102nd St, 5th Floor, New York, NY 10029 (e-mail: Marla.Dubinsky@mssm.edu). Received 30 June, 2018 Accepted 23 September, 2018 Author Contributions: All authors conceived and designed the study. SC acquired data. SC and ES performed statistical analysis. All authors analyzed and interpreted the data. SC drafted the manuscript. All authors critically revised the manuscript for important intellectual content. Conflicts of Interest and Source of Funding: These authors disclose the following: Marla Dubinsky provides consulting services for AbbVie, Janssen, Takeda, Pfizer, Celgene, and UCB. Robert Hirten serves as an advisory board member for Janssen and provides consulting services for Takeda. The remaining authors disclose no conflicts. There are no sources of funding to be disclosed. The authors have no conflicts of interest disclose. © 2018 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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