Fecal microbiota transplantation (FMT) is undoubtedly the most effective therapy for recurrent Clostridioides difficile infection (rCDI). Clinical studies on pediatric FMT did not comprehensively assess microbiota restoration in kids with co-morbidities. For a study, researchers sought to examine how FMT recipient age and underlying co-morbidity affected clinical outcomes and microbiota restoration when they were treated with shared fecal donor sources.

In a single-center, open-label prospective cohort research,18 patients with rCDI received fecal preparation from either a self-designated (1 case) or 2 universal donors. 12 age-matched healthy children and 4 patients with juvenile ulcerative colitis (UC) from a separate serial FMT experiment with a common fecal donor were used as controls for microbiome restoration utilizing longitudinal fecal collections and 16S rRNA gene sequencing.

FMT was considerably more successful in patients with rCDI with no underlying chronic comorbidities when the fecal microbiota composition in post-transplant responders was restored to healthy kid levels. In certain patients with rCDI with co-morbidities, microbiome restoration was not related to clinical remission. Significant increases in Bacteroidaceae, Bifidobacteriaceae, Lachnospiraceae, Ruminococcaceae, and Erysipelotrichaceae were consistently found in pediatric rCDI responders, but Enterobacteraceae declined, corresponding with increased complex carbohydrate breakdown ability. Background disease in the recipient was a significant risk factor impacting FMT results. When contemplating FMT for juvenile rCDI patients with underlying comorbidities, special care should be taken.