A157 FECAL MICROBIOTA TRANSPLANT FOR RECURRENT CLOSTRIDIUM DIFFICILE INFECTION: A SINGLE CENTER PEDIATRIC EXPERIENCE

Fecal microbiota transplantation (FMT) has become an accepted therapy for recurrent Clostridium difficile infection (rCDI), with strong evidence for its high efficacy. Reports of FMT for rCDI have mostly focused on colonoscopic administration, with limited description of nasogastric (NG), nasojejunal (NJ) or gastric-tube (GT) delivery. We present results from our pediatric rCDI-FMT program, which primarily uses NG or GT administration. We retrospectively reviewed all cases of FMT for rCDI at Stollery Children’s Hospital since 2015. In all cases, Health Canada’s FMT guidance document was used to determine indication and potential contraindications for FMT, as well as screening processes for donors. An FMT protocol was developed that included bowel preparation, and was used in all cases. Total fecal slurry dose administered was 37.5-100g (1.3–2.9 g/kg). In total, 5 individual patients received FMT (total 7 procedures), including via NG (1), GT (4), NJ (1) and into cecum via colonscope (1). At time of first CDI, all patients were on either immune modulating medications (3/5), had a recent course of antibiotics (4/5), or both (2/5). Average age at first FMT was 9.0 years (5.2–13.9), with an average of 4 (3–6) toxin positive CDIs prior to first FMT, and 1.2 years (0.5–2.1) from first CDI to FMT. Following FMT, one day of abdominal pain and a single emesis were described in one patient, otherwise no short term complications were documented. Two CDI relapses occurred within 3 weeks of first FMT, requiring repeat FMT (1 NJ, 1 colonoscope). After FMT (including repeated FMT in 2/5 cases), we report all 5 patients (100%) had successfully eradicated CDI, defined as no rCDI within 12 weeks of FMT. With average follow up of 12 months (2.3–34.4), only the 2/5 cases that required a repeat FMT for early relapse have had further CDI, one spontaneously at 15 months and one following antibiotic exposure 4 months post second FMT. We describe FMT via the upper-GI route for 5 pediatric patients with rCDI, with no serious short term complications identified. The overall 100% success rate reported is higher than described elsewhere in the literature, although the small sample size is acknowledged. The upper GI route of FMT delivery has advantages for children, particularly those with an existing GT. However, additional work is required to determine the optimal route of delivery (upper vs lower GI), optimal dose (expressed in g/kg for pediatric patients) and whether bowel prep is required for FMT treatment of rCDI in children. None

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