Fecal microbiota transplantation in pediatric patients with inflammatory bowel disease with and without recurrent Clostridioides difficile infection: a 10-year retrospective cohort study

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Fecal microbiota transplantation (FMT) has been recommended as a treatment option for recurrent Clostridioides difficile infection (CDI). The aim of the study was to investigate the clinical application and outcomes of FMT in pediatric patients with IBD and recurrent CDI and those with IBD without CDI. From May 2013 through April 2023, pediatric patients with IBD who underwent FMT for recurrent CDI or for IBD without CDI at Seoul National University Bundang Hospital were retrospectively enrolled. Data regarding clinical characteristics, endoscopic findings, histopathologic findings, and long-term outcomes were collected and analysed. A total of 18 pediatric patients with IBD underwent FMT, including 11 patients with recurrent CDI and 7 patients without recurrent CDI. Patients received FMT ranging from one to four sessions. The overall CDI eradication rate was 90.0%, the mucosal healing rate was 55.6%, and the clinical remission rate of IBD was 73.7%. Compared to the baseline fecal calprotectin levels (3133.0 [64.0–6000.0] ug/g), there was a statistically significant decrease in fecal calprotectin levels at 3 days (2045.0 [309.0–6000.0] ug/g), 1 month (994.0 [36.0- 6000.0] ug/g), and 6 months (251.5 [13.0–6000.0] ug/g) after FMT ( p = 0.009). Adverse events were observed in 4 of 18 (22.2%) patients. FMT showed a high CDI eradication rate and was generally well tolerated in pediatric patients with IBD. Improvements in clinical and laboratory outcomes were observed after FMT; however, these findings should be interpreted cautiously because of the retrospective exploratory design and limited sample size.