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FMT for Children with Recurrent Clostridium difficile Infection George Hylands Russell, MD, MSc 2014 James W. Freston Conference Chicago, Illinois August.

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Presentation on theme: "FMT for Children with Recurrent Clostridium difficile Infection George Hylands Russell, MD, MSc 2014 James W. Freston Conference Chicago, Illinois August."— Presentation transcript:

1 FMT for Children with Recurrent Clostridium difficile Infection George Hylands Russell, MD, MSc 2014 James W. Freston Conference Chicago, Illinois August 17, 2015

2 I have no financial relationships with any commercial entity to disclose

3 Plan A special population A quick look at the literature NASPGHAN next steps

4 How is Pediatric RCDI different? C. diff is constitutive flora until after 6 months of age, 10 % carriage rate at 1 year 10 fold rise in incidence from Refractory C. diff is rare. Recurrence risk is about 22-30% as in adults. Community acquired C. diff is more common than in adults 23-43% lack antimicrobial exposure history Up to 38% of previously healthy children with RCDI have NAP1/B1/027 serotype Benson L, et al. Infect Control Hosp Epidemiol. 2007;28(11):1233–1235. Khanna S BL, et al. Clin Infect Dis. 2013;56(10): Janqi S, et al. JPGN. 2010; 51:2-7.

5 A special population A vulnerable population Potential life-long ramifications? Long-term safety is a longer term concern Registry and follow up data on outcomes and health status particularly interesting and important

6 Pediatric index case 24 month old girl with community acquired RCDI (6 recurrences) Nasogastric tube delivery Healthy screened paternal donor Safe and well in 24 hours now with 5 years f/u Russell GH, et al. Pediatrics. 2010; 126: e

7 16 month old with community acquired RCDI (6 recurrences) that began at 11 mos of age after Azithromycin for bronchitis 1 st pediatric case documented with colonoscopic delivery Testing and delivery by FMT Working Group Guidelines (Baaken J, et al. Clin Gastro Hep. 2011; 9: ) Improvement in 24 hours. Safe and well in F/U Kahn S, et al. AmJGastro. 2012; 107:

8 Largest pediatric case series Patients who received FMT for RCDI between at MGH for Children 2 nasogastric tube delivery/ 8 by colonoscopic delivery 90% success rate Safe in patients with and without Inflammatory Bowel Disease Russell GH, et al. JPGN. 2014; 58(5):

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11 Counted as a failure Redeveloped CDI after re-admission

12 Russell GH, et al. JPGN. 2014; 58(5): Admitted for severe acute colitis RCDI vs UC 100% better for 5 days then resumed severe bloody diarrhea Never redeveloped CDI Potential fulminant UC flare secondary to FMT?

13 Russell GH, et al. JPGN. 2014; 58(5):

14 Role of colonization and the sensitivity of the PCR test No change in symptoms occurred (even when RCDI was cleared) when RCDI was not clearly causative

15 Columbia experience – Ahead of Print 6 patients with at least 2 RCDI – 4 of whom had comorbidities: IBD, Hirschsprung disease, G-tube dependence Cure rate of 100% All screened parent donors – all received PEG 17 grams BID x 2 days. All by colonoscopy following general FMT Working Group guidelines (Baaken J, et al. Clin Gastro Hep. 2011; 9: ) Potential adverse effect in patient with IBD (developed appendicitis after FMT) Pierog A, et al. JPGN. 2014; /INF

16 NASPGHAN has sponsored the FMT Special Interest Group Standardize pediatric FMT protocols – Standardize recipient/donor consents – Standardize minimal donor testing – Educate and communicate with the Pediatric GI community – Liaison with adult groups and other professional organizations


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