An Intragastric Fecal Microbiota Transplantation Program for Treatment of Recurrent Clostridium difficile in Children is Efficacious, Safe, and Inexpensive - 01/12/17

Doi : 10.1016/j.jpeds.2017.10.016

David E. Brumbaugh, MD ^1,^2,^* , Edwin F. De Zoeten, MD, PhD ^1,², Amy Pyo-Twist, RN ³, Sara Fidanza, RN ³, Shannon Hughes, PA ⁴, Susan A. Dolan, RN, MS ⁵, Jason Child, PharmD ⁶, Samuel R. Dominguez, MD, PhD ^4,⁵
¹ Section of Gastroenterology, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
² Children's Hospital Colorado, Aurora, CO
³ Department of Nursing, Children's Hospital Colorado, Aurora, CO
⁴ Section of Infectious Diseases, Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO
⁵ Department of Epidemiology, Children's Hospital Colorado, Aurora, CO
⁶ Department of Pharmacy, Children's Hospital Colorado, Aurora, CO

^*Reprint requests: David E. Brumbaugh, MD, Children's Hospital Colorado, 13123 E. 16th Ave, B290, Aurora, CO 80045.Children's Hospital Colorado13123 E. 16th AveB290AuroraCO80045

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Abstract

Objective

To assess the safety, efficacy, and relative expense of a nurse-led fecal microbiota transplantation (FMT) program for the treatment of recurrent Clostridium difficile infection (CDI).

Study design

Retrospective cohort study design in children aged 1-18 years with recurrent CDI. The intervention was an intragastric FMT with stool derived from a donor stool bank. Primary outcome was resolution of diarrhea at 3 months post-transplantation. A secondary analysis compared charge data associated with FMT by intragastric delivery vs administration by colonoscopy or nasoduodenal tube.

Results

A total of 47 intragastric FMT procedures were performed in 42 children (median age 9 years) with recurrent CDI. Response to treatment varied by disease status, with 94% success in previously healthy children, 75% in medically complex children, and 54% in children with inflammatory bowel disease (P = .04). FMT via intragastric delivery showed lower facility and professional charges by 85% and 78% compared with delivery via colonoscopy and radiology-placed nasoduodenal tube, respectively. The use of stool derived from a donor stool bank decreased charges by 49% compared with charges associated with the use of a donor who was a relative.

Conclusion

A nurse-led intragastric FMT procedure using stool derived from a donor stool bank is a relatively inexpensive and efficacious treatment for recurrent CDI in children. Intragastric FMT success in children was attenuated by the presence of underlying disease, particularly inflammatory bowel disease.

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Abbreviations : CDI, FMT, GI, IBD, NGT, RN