Division of Gastroenterology, Department of Pediatrics, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA.
Pediatrics. 2010 Jul;126(1):e239-42. doi: 10.1542/peds.2009-3363. Epub 2010 Jun 14.
Clostridium difficile infection (CDI) is a potentially serious emerging infectious disease. The incidences of CDI in childhood and CDI cases complicated by relapses have increased by 50% or more in North America during the past 2 decades. We report here the case of a 2-year-old child with relapsing CDI caused by the epidemic strain BI/NAP1/O27 that was refractory to Saccharomyces boulardii and Lactobacillus rhamnosus GG probiotics and to intensive therapy with traditional (metronidazole, vancomycin) and experimental (rifaximin, nitazoxanide) antibiotics despite its apparent antimicrobial-susceptible phenotype. After excluding other infectious causes of diarrhea and inflammatory bowel disease, we designed a protocol to safely administer fecal bacteriotherapy via a temporary nasogastric tube. We demonstrated for the first time that fecal transplantation is practical and effective for treating relapsing CDI in a young child. We recommend that this strategy be reserved for complicated cases of CDI that fail conventional therapy until randomized studies can confirm the safety and effectiveness of fecal bacteriotherapy in children.
艰难梭菌感染（CDI）是一种潜在的严重新发传染病。在过去的 20 年中，北美的儿童艰难梭菌感染（CDI）发病率和复发相关 CDI 病例增加了 50%或更多。我们在此报告了一例由流行株 BI/NAP1/O27 引起的复发性 CDI 的 2 岁儿童病例，该患儿对布拉氏酵母菌和鼠李糖乳杆菌 GG 益生菌以及传统（甲硝唑、万古霉素）和实验（利福昔明、硝唑尼特）抗生素的强化治疗均无反应，尽管其表现出明显的抗菌药物敏感表型。在排除了其他腹泻和炎症性肠病的感染性病因后，我们设计了一个通过临时鼻胃管安全进行粪便细菌治疗的方案。我们首次证明粪便移植对于治疗年轻儿童的复发性 CDI 是实用且有效的。我们建议，在随机研究能够证实粪便细菌治疗在儿童中的安全性和有效性之前，该策略应保留用于常规治疗失败的复杂 CDI 病例。
