Section of Gastroenterology, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO; Children's Hospital Colorado, Aurora, CO.
Section of Gastroenterology, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO; Children's Hospital Colorado, Aurora, CO.
J Pediatr. 2018 Mar;194:123-127.e1. doi: 10.1016/j.jpeds.2017.10.016. Epub 2017 Dec 1.
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).
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.
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.
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.
评估由护士主导的粪便微生物群移植（FMT）方案治疗复发性艰难梭菌感染（CDI）的安全性、疗效和相对费用。
对 1-18 岁复发性 CDI 患儿进行回顾性队列研究。干预措施是通过胃内途径给予来自供体粪便库的粪便进行 FMT。主要结局是移植后 3 个月腹泻缓解。二次分析比较了胃内途径给药与结肠镜或经鼻十二指肠管给药的 FMT 相关费用数据。
共对 42 例复发性 CDI 患儿进行了 47 例胃内 FMT 操作（中位年龄为 9 岁）。治疗反应因疾病状态而异，既往健康的患儿成功率为 94%，医疗复杂的患儿为 75%，炎症性肠病患儿为 54%（P=0.04）。与结肠镜和放射科放置的经鼻十二指肠管相比，胃内途径给药的设施和专业费用分别降低了 85%和 78%。与使用亲属来源的粪便相比，使用来自供体粪便库的粪便可降低 49%的费用。
由护士主导的、使用来自供体粪便库的粪便的胃内 FMT 操作是治疗儿童复发性 CDI 的一种相对廉价且有效的方法。儿童胃内 FMT 的成功率因潜在疾病的存在而降低，特别是炎症性肠病。
