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Fungi microbiota transplantation is safe and effective in children with C. difficile


C. difficile

This photograph depicts difficile clostridium colonies after 48hrs growth on a blood agar plate; Magnified 4.8X. C. difficile, anaerobic gram-positive rod, is the most identified cause of diarrhea associated with antibiotics (AAD). This accounts for about 15-25% of all episodes of AAD. Credit: CDC

Diarrhea caused by Clostridiods (formerly Clostridium) Depussyl infections is on the rise in children; One population-based study found a 12.5-fold increase in morbidity between 1991 and 2009. For reasons that are not clear, C. difficile is more common in children without the usual risk factors, such as hospitalization or exposure to antibiotics. One thing is known that C. diff disease is associated with microbiota in a different intestine.

Implantation of fecal microbiota (FMT), or removal of a stool from a healthy donor to the patient, has been found to be highly effective in the transformation of severe clostridides into diarrhea inflammation in adults. C. Depsil is known to be associated with microbiota in the intestine, and the implanted scalp appears to restore normal balance.

Is FMT helpful in children with C. difficile? A new study in the journal Clinical Gastroenterology and Pathology, The largest FMT study in children so far, found it safe and effective and also predictors of success.

Diarrhea disease from C. difficile increase in children. One population-based study found a 12.5-fold increase in the incidence between 1991 and 2009. For reasons that are not clear, C. difficile is more prominent without risk factors such as hospitalization or exposure to antibiotics.

"Our results are pretty exciting, considering that the C difference is exhausting and expanding in children, not only those with known risk factors but also healthy children in the past," says Stacey Kahn, a gastroenterologist at Children's Hospital Boston. Kahn led the research with Nicholson, MD, MPH, at the Vanderbilt University Hospital and Richard Richards Center, MD, Ph.D. Texas Children's Hospital.

Factors in successful FMT

The study involved 372 patients with C. C. difficile, aged 11 months to 23 years, with FMT in one of 18 centers for children across the US FMT was given in various ways including colonoscopy, nasogastric tube, frozen capsules, or enemas.

Two-month results were available for 335 patients. Of these, 81% did not repeat C. difficile infection after single treatment. Some of the remaining patients had a second round of FMT; Half of them did not see C. C. difficile, increasing their overall success rate to 87%.

The success was 2.7 times higher when FMT came in the form of fresh feces compared with previously frozen, 2.4 times more when patients received stool using colonoscopy than other methods. Patients without a feeding tube (considered to be a risk factor for C. difficile) were twice as likely to respond, and those with one early C. difficile infection had a 20% higher risk of success. Age does not seem to factor.

FMT was also more likely to be successful in newly treated patients, perhaps because of tight protocols surrounding the donor choice and treatment.

"The success rates we found were similar to those seen in adults, but they seem to be associated with fewer complications," says Kahn. "We do not understand why colonoscopy, a fresh stool, and a newer FMT treatment were associated with higher success rates, and these questions provide the basis for future FMT research in children," he said.

As for safety, 6% of patients had FMT-related side effects. Most of them were mild and included diarrhea, vomiting and swelling. Of the approximately one-third of patients with inflammatory bowel disease, 2.5% had a severe conflagration of their disease requiring them to be hospitalized. But it was not clear that there was anything to do with FMT.

Tapping the FMT's potential

Kahn notes that the study was limited by its retrospective design and a relatively short period of follow-up. "We use data to help plan controlled future studies," she says. "We also need long-term studies to investigate the long-term impact and safety of transplanting microbiome from one person to another. Many questions need to be answered."

The group also studies FMT for children with other forms of colitis, inflammatory bowel disease (IBD).

"We want to take advantage of FMT's therapeutic potential and begin to understand how we can use and treat microbiology to treat diseases other than C. diff," says Kahn.

Antibiotics and PPIs are associated with an increased risk of infectious diarrhea in children

more information:
Maribeth R. Nicholson et al., Effectiveness of Fungi Microbiota Transplantation for Clostridium Difficile Infection in Children, Clinical Gastroenterology and Pathology (2019). DOI: 10.1016 / j.cgh.2019.04.037

Provided by
Boston Children 's Hospital

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Fecal microbiota transplantation was found safe and effective in children with C. difficile (2019, May 16)
May 16, 2019

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