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Pediatric Nephrology
Published in: Pediatric Nephrology 4/2024

30-09-2023 | Clostridioides Difficile | Original Article

Effects of fecal microbiota transplantation for recurrent Clostridium difficile infection in children on kidney replacement therapy: a pilot study

Authors: An Samaey, Jorge Francisco Vázquez-Castellanos, Clara Caenepeel, Pieter Evenepoel, Séverine Vermeire, Jeroen Raes, Noël Knops

Published in: Pediatric Nephrology | Issue 4/2024

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Abstract

Background

Recurrent Clostridium difficile infection (rCDI) is a rising problem in children with chronic diseases. Fecal microbiota transplantation (FMT) is a recent alternative for rCDI patients who do not respond to conventional treatment. FMT could have an additional positive effect on the intestinal dysbiosis and accumulation of uremic retention molecules (URM) associated with chronic kidney disease (CKD). Our aim was to investigate the clinical efficacy of FMT for rCDI in children with CKD together with the effect on dysbiosis and URM levels.

Methods

We analyzed stool and blood samples before and until 3 months after FMT in 3 children between 4 and 8 years old with CKD and rCDI. The microbiome was analyzed by 16 s rRNA sequencing. URM were analyzed with ultra-performance liquid chromatography-tandem mass spectrometry. CRP and fecal calprotectin were analyzed as parameters for systemic and gut inflammation, respectively.

Results

CDI resolved after FMT in all three without adverse events; one patient needed a second FMT. No significant effect on CRP and calprotectin was observed. Stool samples demonstrated a reduced richness and bacterial diversity which did not improve after FMT. We did observe a trend in the decrease of specific URM up to 3 months after FMT.

Conclusion

FMT is an effective treatment for rCDI in patients with CKD. Analysis of the microbiome showed an important intestinal dysbiosis that, besides a significant reduction in Clostridium difficile, did not significantly change after FMT. A trend for reduction was seen in some of the measured URM after FMT.

Graphical abstract

Appendix
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Metadata
Title
Effects of fecal microbiota transplantation for recurrent Clostridium difficile infection in children on kidney replacement therapy: a pilot study
Authors
An Samaey
Jorge Francisco Vázquez-Castellanos
Clara Caenepeel
Pieter Evenepoel
Séverine Vermeire
Jeroen Raes
Noël Knops
Publication date
30-09-2023
Publisher
Springer Berlin Heidelberg
Published in
Pediatric Nephrology / Issue 4/2024
Print ISSN: 0931-041X
Electronic ISSN: 1432-198X
DOI
https://doi.org/10.1007/s00467-023-06168-6

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