Jugulete Gh. 1, 2, Merișescu Madălina 1, 2, Luminos Monica 1, 2
1 University of Medicine and Pharmacy” Carol Davila”, Bucharest
2 National Institute for Infectious Diseases “Prof. Dr. Matei Balș”, Bucharest
Abstract
Clostridium difficile infection (CDI) is an intestinal condition, mostly occurring due to extended antimicrobial therapy but it can also be consequent to the host’s immunodepression. Children can be asymptomatic carriers, especially toddlers below the age of two, where Clostridium difficile is more frequently encountered-in the saprophytic intestinal flora. However, there are cases of CDI in older children, predominantly in the aftermath of excessive administration of antibiotics or it can appear as a result of severe immunosuppressive affections (malignity due to chemotherapy, primary or acquired immunodeficiency- HIV/AIDS infection). These cases can have severe clinical forms (pseudomembranous colitis) whose onset can be represented by toxic phenomena and even death, due to the lack of proper treatment. This material aims to present our clinical experience regarding the management of severe recurrent Clsotridium Difficile Infection cases that required intestinal bacterial colonisation. This procedure is frequent in adults who do not respond to classic antimicrobial therapy. In children, few cases of faecal transplantation have been reported so far, as alternative therapy in the case of recurrent CDI, unresponsive to antimicrobial therapy. We present four clinical cases of paediatric Clostridium difficile where we applied intestinal bacterial colonisation with faecal microbiota transplantation from patients’ next of kin (the child’s mother or father). In three cases we used the abovementioned technique after having applied the entire therapeutic protocol and after the onset of recurrences (metronidazole, vancomycin, prolonged course of vancomycin therapy with gradual dose reduction). All three cases of pseudomembranous colitis were consequent to prolonged administration of antibiotics, one of them being with congenital IgA, while the other two were immunocompetent children. Furthermore, we applied intestinal bacterial colonization in a CDI child with unspecified underlying congenital colitis that failed to be treated based on the classic therapeutic protocol due to multiple allergies (including to metronidazole and vacomycin). In all cases intestinal bacterial colonisation was administered without any incident, with favourable evolution, no reoccurrence and with a high success rate rendering the cases as a success. Thus, one may state that intestinal bacterial colonisation in children with Clostridium Difficile Infection is a therapeutic procedure that can be adopted by guidelines treating this affection, especially for those cases that are unresponsive to antibiotics but also for cases that reject classic therapy.