2121. Analysis of treatment outcomes for recurrent Clostridium difficile infections and fecal microbiota transplantation (FMT) in a pediatric hospital.
Session: Poster Abstract Session: Clostridium difficile: Therapeutics
Saturday, October 29, 2016
Room: Poster Hall
Background: Clostridium difficile infection (CDI) is one of the most common nosocomial infections in the United States. The incidence of CDI in children has increased significantly in the last 20 years and up to 35% of pediatric patients develop recurrent infections. Therefore, it is imperative to further analyze the incidence and relapse rates of CDI in the pediatric population and determine the most effective treatment modalities.

Methods: This was a retrospective cohort study for patients aged 1-21 years treated for CDI at our institution from January 2010 – December 2014

Results: We identified 201 patients, accounting for 231 separate episodes of CDI. Fourteen percent of those with CDI had known or were found to have IBD. Roughly 36% of patients were immunocompromised, and 49% had recent antibiotic exposure. Ten to 14 days of oral metronidazole was the most common initial treatment (70%) followed by vancomycin monotherapy (15%) and combination therapy (12%). About 28% of cases had at least one documented recurrence. For initial treatment of CDI, 78% of those treated with vancomycin monotherapy relapsed, whereas only 18% of those treated with metronidazole had recurrent CDI. Patients that had a first recurrence were treated equally with vancomycin or metronidazole (27/58), and the majority of second occurrences were treated with metronidazole. FMT, though only used in 5% of cases, had an 83% success rate.

Conclusion: Our results reflect a lower recurrence rate (28%) compared to the existing pediatric literature (35%). Recent antibiotic use, though thought to be a major trigger for the majority of CDI, was a risk factor in less than half of cases; our data suggest that immunosuppression plays a role in host susceptibility to CDI. Metronidazole had a high success rate as a first line agent. Though currently reserved for multiple resistant cases, FMT is highly successful and can be considered earlier in the clinical course as a definitive treatment option for children with recurrent CDI.

Aileen Aldrich, MD, Grand Rapids Medical Education Partners, Grand Rapids, MI, Taylor Argo, BS, Michigan State University College of Human Medicine, Grand Rapids, MI and Rosemary Olivero, MD, Helen DeVos Children's Hospital, Grand Rapids, MI

Disclosures:

A. Aldrich, None

T. Argo, None

R. Olivero, None

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