Gastroenterology, Hepatology & Nutrition, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital.
USDA/ARS Children's Nutrition Research Center.
J Pediatr Gastroenterol Nutr. 2022 Feb 1;74(2):227-235. doi: 10.1097/MPG.0000000000003336.
Fecal microbiota transplantation (FMT) is arguably the most effective treatment for recurrent Clostridioides difficile infection (rCDI). Clinical reports on pediatric FMT have not systematically evaluated microbiome restoration in patients with co-morbidities. Here, we determined whether FMT recipient age and underlying co-morbidity influenced clinical outcomes and microbiome restoration when treated from shared fecal donor sources.
Eighteen rCDI patients participating in a single-center, open-label prospective cohort study received fecal preparation from a self-designated (single case) or two universal donors. Twelve age-matched healthy children and four pediatric ulcerative colitis (UC) cases from an independent serial FMT trial, but with a shared fecal donor were examined as controls for microbiome restoration using 16S rRNA gene sequencing of longitudinal fecal specimens.
FMT was significantly more effective in rCDI recipients without underlying chronic co-morbidities where fecal microbiome composition in post-transplant responders was restored to levels of healthy children. Microbiome reconstitution was not associated with symptomatic resolution in some rCDI patients who had co-morbidities. Significant elevation in Bacteroidaceae, Bifidobacteriaceae, Lachnospiraceae, Ruminococcaceae, and Erysipelotrichaceae was consistently observed in pediatric rCDI responders, while Enterobacteriaceae decreased, correlating with augmented complex carbohydrate degradation capacity.
Recipient background disease was a significant risk factor influencing FMT outcomes. Special attention should be taken when considering FMT for pediatric rCDI patients with underlying co-morbidities.
粪菌移植（FMT）可被认为是治疗复发性艰难梭菌感染（rCDI）最有效的方法。儿科 FMT 的临床报告尚未系统评估合并症患者的微生物组恢复情况。在此，我们确定 FMT 受者年龄和潜在合并症是否会影响从共享粪便供体来源治疗时的临床结果和微生物组恢复。
18 名 rCDI 患者参加了一项单中心、开放标签的前瞻性队列研究，他们接受了来自指定供体（单个病例）或两个通用供体的粪便制剂。作为微生物组恢复的对照，从独立的连续 FMT 试验中选择了 12 名年龄匹配的健康儿童和 4 名儿科溃疡性结肠炎（UC）病例，这些病例来自共享的粪便供体，并使用 16S rRNA 基因测序对纵向粪便样本进行检测。
在没有潜在慢性合并症的 rCDI 受者中，FMT 效果显著更优，移植后应答者的粪便微生物组组成恢复到健康儿童的水平。在一些患有合并症的 rCDI 患者中，微生物组重建与症状缓解无关。在儿科 rCDI 应答者中，始终观察到拟杆菌科、双歧杆菌科、lachnospiraceae、瘤胃球菌科和肠杆菌科显著升高，而肠杆菌科减少，与复杂碳水化合物降解能力增强相关。
受者背景疾病是影响 FMT 结果的重要危险因素。在考虑为患有潜在合并症的儿科 rCDI 患者进行 FMT 时，应特别注意。
