Fecal Microbiota Transplantation For Pediatric Recurrent Clostfidium Difficile Infection Treatment And The Intestinal Microbiota Composition Analysis

Clostridium difficile infection(CDI)is defined as infection with clostridium difficile.Clostridium difficile(C.difficile)is an anaerobic gram-positive,spore-forming,toxin-producing bacillus that can cause intestinal disease varying from a mild diarrheal illness to severe colitis,and even severe pseudomembranous colitis.The incidence of CDI is increasing these years,showing the recurrence rate,severity and mortality increased year by year.Microbiota disturbance was found one of the most important factors that can cause recurrent clostridium difficile infection.Fecal microbiota transplantation(FMT)is the administration of a solution of fecal matter from a donor into the intestinal tract of a recipient in order to directly change the recipient’s microbial composition and to restore its intestinal balance.Currently,FMT can successfully treat recurrent clostridium difficile infection(RCDI).The cute rate was about 80%-90%.At present,the study of pediatric FMT is not completed,especially the relevant clinical data.The 16 S rRNA gene is considered the gold standard for bacterial identification.Based on the 16 S rRNA gene analysis technique,especially the use of the Deep Sequencing technique can help to explore the composition of the intestinal microbiota,to evaluate the effect of antibiotic of the intestinal microbiota,and to evaluate the influence of use of probiotics.Besides,it can also help to evaluate the intesinal microbiota before and after FMT.In this study,we explored the clinical benefit of FMT in pediatric recurrent clostridium infection,and analyze the composition of intestinal microbiota before and after FMT.Fecal microbiota transplantation for pediatric recurrentclostridium difficile infection treatmentObjective: To evaluate the clinical efficacy of fecal microbiota transplantation on children with recurrent clostridium difficile infection(RCDI).Methods: This study cohort comprised 6 patients who were diagnosed as RCDI and treated with FMT at Shanghai Children’s Hospital between 2014 and 2016.We analyze the sex,age,clinical characteristics,abdominal CT scan and detailed information of FMT.Results: Among the 6 patients,4 were male,2 children received a single FMT treatment and achieve clinical remission,4 children were treated with multiple FMT in order to achieve clinical remission.Single FMT success rate was 33%.All patients had no severe side effects either during the FMT or after FMT.Conclusions: FMT can be used to treat children with recurrent,refractory CDI,and it is safe and tolerant.Analysis of microbial composition in recurrent clostridiumdifficile infection children treated with fecal microbiotatransplantationObjective: To explore microbial composition in recurrent clostridium difficile infection(RCDI)children treated with fecal microbiota transplantation.Methods: 16 S rRNA sequencing was used to analyze the microbiota composition of 4 RCDI children before and after FMT,as well as 10 healthy volunteers.Cross-group and intra-individual differences in microbial community diversity and similarity were compared at different levels.Results: The original patients’ microbiota had low diversity.At the phyla,class,order,family,and genera levels,the microbiota composition between patients and volunteers was different.In comparison,the volunteer community had significantly higher diversity and evenness.At the phyla level,fecal samples of RCDI patients were rich in members of the Bacteroidetes and Proteobacteria.At the class level,the Gammaprotebacterias enriched,and the Bacteroidia decreased.At the order level,there were also differences.Fecal samples of RCDI patients were rich in members of the Enterobacterialia,and were poor in Bacteroidales.At the family level,the Enterobacteriaceae was aboundant in members;however,the Bacteroidaceae and Ruminococcaceae were poor.At the genera level,increased abundance of klebsiella and erwinia,and decreased abundance of Bacteroides,Faecalibacterium and Sutterella were observed.Samples taken after each transplant demonstrated quick remodeling towards the donor’s sample composition coinciding with symptom resolution,and these communities remained stable in each patient.Conclusions: The diversity of the intestinal microbiota in children with RCDI decreased.FMT can significantly increase the diversity of the intestinal microbiota composition in children with RCDI,which indicates that a wide range of microbiota profiles may effectively treat RCDI.Besides,the microbiota composition of FMT recipients shifted towards that of the donor.In this study,16 S rRNA sequencing was used to analyze the changes of intestinal microbiota composition in children with RCDI before and after FMT,and it can help to study more information about the pediatric intestinal microbiota composition.