Department of Pediatrics.
Department of Medicine, Susan and Leonard Feinstein IBD Clinical Center, Icahn School of Medicine at Mount Sinai, New York, NY.
J Pediatr Gastroenterol Nutr. 2019 Mar;68(3):343-347. doi: 10.1097/MPG.0000000000002172.
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 patients with IBD with RCDI, and the data in pediatrics are limited. We aimed to determine the effectiveness of FMT for RCDI in established pediatric patients with IBD.
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.
Of the 8 eligible patients, 6 had ulcerative colitis, 1 had IBD-unspecified, and 1 had Crohn 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.
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 C difficile infection after 60 days in these patients.
复发性艰难梭菌感染（RCDI）会增加炎症性肠病（IBD）患者的发病率和死亡率。粪菌移植（FMT）已被证实对非 IBD 患者的 RCDI 非常有效，治愈率高达 91%。但在患有 RCDI 的 IBD 患者中，FMT 的成功率并未得到同样的报道，且儿科数据有限。我们旨在确定 FMT 治疗 IBD 患儿 RCDI 的有效性。
我们对在一家三级 IBD 中心接受结肠镜下 FMT 治疗的 IBD 确诊患儿（≥3 次）的 RCDI 进行了回顾性图表审查。主要结局是 FMT 后 60 天内 RCDI 的发生率。次要结局是 6 个月时的复发率、结肠切除术率和复发时间。
8 名符合条件的患者中，6 名为溃疡性结肠炎，1 名为 IBD 未特指，1 名为克罗恩病。中位（四分位距）年龄为 13（11-14）岁。所有患者在 FMT 时均使用万古霉素。2 名（25%）患者在 FMT 后 60 天内发生 RCDI，另有 3 名患者在 60 天至 6 个月期间发生 RCDI。中位复发时间为 101（40-139）天。2 名（25%）复发的患者在 FMT 后接受了结肠切除术。
FMT 治疗 RCDI 的 60 天治愈率为 75%，可能是小儿 IBD 的一种有效治疗选择。然而，这些患者在 60 天后似乎有相当高的艰难梭菌感染复发率。
