BACKGROUND & AIMS Fecal microbiota transplantation (FMT) is commonly used to treat Clostridium difficile infection (CDI). CDI is an increasing cause of diarrheal illness in pediatric patients, but the effects of FMT have not been well studied in children. We performed a multi-center retrospective cohort study of pediatric and young adult patients to evaluate the efficacy, safety, and factors associated with a successful FMT for the treatment of CDI. METHODS We performed a retrospective study of 372 patients, 11 months to 23 years old, who underwent FMT at 18 pediatric centers, from February 1, 2004, to February 28, 2017; 2-month outcome data were available from 335 patients. Successful FMT was defined as no recurrence of CDI in the 2 months following FMT. We performed stepwise logistic regression to identify factors associated with successful FMT. RESULTS Of 335 patients who underwent FMT and were followed for 2 months or more, 271 (81%) had a successful outcome following a single FMT and 86.6% had a successful outcome following a first or repeated FMT. Patients who received FMT with fresh donor stool (odds ratio [OR], 2.66; 95% CI, 1.39-5.08), underwent FMT via colonoscopy (OR, 2.41; 95% CI, 1.26-4.61), did not have a feeding tube (OR, 2.08; 95% CI, 1.05-4.11), or had 1 less episode of CDI before FMT (OR, 1.20; 95% CI, 1.04-1.39) had increased odds for successful FMT. Seventeen patients (4.7%) had a severe adverse event during the 3-month follow-up period, including 10 hospitalizations. CONCLUSIONS Based on the findings from a large multi-center retrospective cohort, FMT is effective and safe for the treatment of CDI in children and young adults. Further studies are required to optimize the timing and method of FMT for pediatric patients-factors associated with success differ from those of adult patients.

中文翻译：

---

粪便微生物群移植治疗儿童艰难梭菌感染的疗效。

背景和目的 粪便微生物群移植 (FMT) 通常用于治疗艰难梭菌感染 (CDI)。CDI 是引起儿科患者腹泻病的一个越来越多的原因，但 FMT 对儿童的影响尚未得到很好的研究。我们对儿童和年轻成人患者进行了一项多中心回顾性队列研究，以评估与成功 FMT 治疗 CDI 相关的有效性、安全性和相关因素。方法 我们对 2004 年 2 月 1 日至 2017 年 2 月 28 日在 18 个儿科中心接受 FMT 的 372 名年龄在 11 个月至 23 岁之间的患者进行了回顾性研究；2 个月的结果数据来自 335 名患者。FMT 成功定义为 FMT 后 2 个月内没有 CDI 复发。我们执行逐步逻辑回归来确定与成功 FMT 相关的因素。结果 在接受 FMT 并随访 2 个月或更长时间的 335 名患者中，271 名 (81%) 在单次 FMT 后取得成功，86.6% 在第一次或重复 FMT 后取得成功。接受新鲜供体粪便 FMT 的患者（比值比 [OR]，2.66；95% CI，1.39-5.08），通过结肠镜检查接受 FMT（OR，2.41；95% CI，1.26-4.61），没有饲管(OR, 2.08; 95% CI, 1.05-4.11)，或在 FMT 之前减少 1 次 CDI (OR, 1.20; 95% CI, 1.04-1.39) 增加了成功 FMT 的几率。17 名患者 (4.7%) 在 3 个月的随访期间出现严重不良事件，其中 10 人住院。结论 基于大型多中心回顾性队列研究的结果，FMT 可有效且安全地治疗儿童和年轻人的 CDI。需要进一步的研究来优化儿科患者 FMT 的时机和方法——与成功相关的因素与成人患者不同。