Children's Hospital Colorado

Preliminary Outcomes of Nurse-Driven Fecal Transplant

Digestive Health | July 25, 2018

 

For families

  • A Clostridium difficile infection (CDI) can occur when a child’s colon is infected by Clostridium difficile (C. diff) bacteria. Symptoms include fever, diarrhea, vomiting and stomach pain. 
  • If the infection continues to come back despite antibiotics, the next step in treatment is a procedure called a fecal microbiota transplant (FMT) to replace the infected bacteria with healthy bacteria.
  • Nurses in our Digestive Health Institute can successfully administer FMT treatment to patients in a clinic setting.

 

For health professionals

  • Our nurses are among the first and only nurses to perform FMT treatment on pediatric patients with CDI. 
  • While physicians typically perform FMT treatment, our study indicates that nurses can successfully administer fecal transplants.
  • Patients with IBD experience less effective FMT treatment compared to other patients.

Why a child may need a fecal transplant

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). 

Clinical background: fecal microbiota transplantation

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.

Research methods: stool transplants administered by nurses

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.

Determining success of the fecal transplant study

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.

Research results: the majority of patients were successfully treated by nurse-driven fecal transplants

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.

Study participants / success rate:                                   Inflammatory bowel disease – 29% / 69.2% Otherwise healthy – 38% / 92.3% Medically complex – 33% 73.3 Route of transplantation NGT 71% GT 23% Oral capsule 4% Ileostomy 2%

No complications were observed from nurse-driven stool transplants

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.

Research conclusions: nurses can successfully perform fecal transplants

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.

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