AUTHOR=Li Xiaolu , Gao Xuefeng , Hu Hui , Xiao Yongmei , Li Dan , Yu Guangjun , Yu Dongbao , Zhang Ting , Wang Yizhong 

TITLE=Clinical Efficacy and Microbiome Changes Following Fecal Microbiota Transplantation in Children With Recurrent Clostridium Difficile Infection

JOURNAL=Frontiers in Microbiology

VOLUME=Volume 9 - 2018

YEAR=2018

URL=https://www.frontiersin.org/journals/microbiology/articles/10.3389/fmicb.2018.02622

DOI=10.3389/fmicb.2018.02622

ISSN=1664-302X

ABSTRACT=Fecal microbiota transplantation (FMT) has been showed as an effective treatment for recurrent clostridium difficile infection (RCDI) in adults. We aim to evaluate the clinical efficacy of FMT in treating children with RCDI, explore fecal microbiota changes during FMT treatment. In this single-center prospective pilot study, 11 RCDI subjects with a median age of 3.5 years treated with FMT at Shanghai Children’s Hospital between 2014 and 2017 were enrolled. A total of 16 FMT were performed, 81.2% (13/16) through upper gastrointestinal tract route with a nasointestinal tube and 18.8% (3/16) by lower gastrointestinal tract route with a rectal tube. All pediatric RCDI patients were cured (11/11, 100%) by FMT. The cure rate of single FMT was 63.6% (7/11), and 36.4% (4/11) cases performed with 2 or 3 times of FMT. Mild adverse events were reported in 4 children (4/11, 36.4%), including transient diarrhea, mild abdominal pain, transient fever and vomit. Gut microbiota dysbiosis in pediatric RCDI patients prior to FMT was represented by a reduced biodiversity via 16S rRNA gene sequencing. Both the richness and diversity of gut microbiota were improved in the pediatric RCDI patients after FMT, and the bacteria community was shifted closer to the donor and healthy control group. Multiple bacteria that significantly different with the donor and health controls were uplifted after FMT, however, some of them drifted toward baseline 30 (or longer) days after FMT, including the genera. FMT re-directed gut microbiome functions of pediatric RCDI towards a health state and maintained through the study, while some functions took a week or longer to achieve a health level. Our results indicate that it is safe and tolerant to use FMT in treating pediatric RCDI. FMT shifted the intestinal microbiome composition and functions in children with RCDI towards a healthy state.