Analysis of Treatment Outcomes for Recurrent clostridium difficile Infections and Fecal Microbiota Transplantation in a Pediatric Hospital.

Clostridium difficile infection (CDI) is one of the most common nosocomial infections in the United States, with an increasing incidence in children. Approximately 20% of pediatric patients develop recurrent infections. It’s imperative to further analyze the incidence of recurrent CDI in the pediatric population and determine the most effective treatments. The primary goal of this study is to characterize children with recurrent CDI at our institution, including both hospital-acquired (HA-CDI) and community-acquired (CA-CDI) cases, summarize the various treatments utilized, including fecal microbiota transplant (FMT), and compare their success rates. A retrospective cohort study of pediatric patients aged 1-21 years treated for CDI at a single institution from January 2010 – December 2014 was performed. There were 175 subjects with 215 separate episodes of CDI. Oral metronidazole was the most common initial treatment (145/207, 70%) followed by oral vancomycin (30/207, 15%), with recurrence rates of 30% (42/145) and 37% (11/30), respectively. Twenty-nine percent (63/215) of all initial CDI cases had at least one documented recurrence. Using multivariate analysis, subjects with HA-CDI were 2.6 times less likely to recur than those with CA-CDI (OR: 0.39; 95% CI: 0.18-0.85; p=0.018). The overall success rate for FMT at our institution was 10/12 (83%). Our data show cases of HA-CDI were less likely to recur compared with CA-CDI. Though currently reserved for multiply-recurrent cases, FMT was highly successful in our small cohort. More studies on FMT should be conducted to further evaluate its usefulness in the treatment of recurrent CDI in children.