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When pediatric patients experience recurring Clostridium difficile infections (CDI) that do not resolve with antibiotics, the standard of care for treatment is fecal microbiota transplantation (FMT).
FMT uses fecal material from a stool donor bank. FMT can be administered in several ways: via colonoscopy, nasogastric tube (NGT) or gastrostomy tube (G-tube), or with a retention enema or oral capsule if the NGT is not an option. With the exception of the colonoscopy, which must be performed by a physician, nurses can be trained to perform the procedure for the benefit of cost savings without sacrificing the quality of care.
The Digestive Health Institute at Children’s Hospital Colorado is among the first to use registered nurses for FMT.
In this study, FMT data was collected at Children’s Colorado between mid-2015 and mid-2016. Eligible patients were 1 to 21 years old, were diagnosed with recurrent C. diff and had received two failed courses of antibiotics (one of which was oral Vancomycin). During the study period, nurses administered FMT treatment to 45 pediatric patients in an ambulatory setting. The patients received follow-up via telephone two weeks, three months and six months after the procedure.
The success or failure of the fecal transplant treatment was determined at three months following the procedure. Treatment was considered successful when the patient’s symptoms were resolved. Treatment was considered a failure when the patient’s symptoms of abdominal pain, diarrhea and hematochezia (the passage of fresh blood, usually in or with stools) returned and the patient’s stool tested positive for the C. diff toxin.
Of the 45 patients who received FMT, 37 (82.2%) were successfully treated, but success varied depending on any underlying disease. Otherwise healthy children with recurrent C. diff infection responded favorably to FMT more than 90% of the time. Patients with inflammatory bowel disease (IBD) experienced less success from the treatment than other patients.
There were no complications with the NG tube placement. Less than 10% of children experienced a single episode of vomiting after the FMT, but recovered quickly.
Compared to published standards, nurse-driven FMT treatment is successful. The presence of IBD appears to decrease the effectiveness of FMT for treatment of pediatric patients experiencing recurrent CDI.