MDNews - Greater Kansas

FECAL MICROBIOTA TR ANSPL ANTATION £FMT¤ VIA NA SOGA STRIC FEEDING TUBE £NGT¤ IS A CHE APER YE T SIMIL ARLY EFFECTIVE TRE ATMENT ME THOD FOR RECURRENT CLOSTRIDIUM DIFFICILE INFECTION £CDI¤ IN CHILDREN WHEN COMPARED WITH FMT VIA COLONOSCOPY OR NA SODUODENAL TUBE, A STUDY FROM CHILDREN'S HOSPITAL COLOR ADO HA S FOUND. THE INCIDENCE OF CDI is increasing in what were formerly considered low-risk populations, according to studies in The Pediatric Infectious Disease Journal and Clinical Infectious Diseases. These groups include children in both hospital and com- munity settings. "In the past, it was thought that CDI mostly occurred after antibiotic treat- ments wiped out good flora [in the gut]," says Ma rk Ba r tlett, MD, Consulta nt in Pediatric Gastroenterolog y at the Mayo Clinic. " We never thought you could acquire it from another person or the community." While researchers are still speculating about the reason for the increase in CDI — current hypotheses include increased antibiotic resistance and the rise of more aggressive strains of C-di– — the search for new treatment options against recurrent and severe CDI has proved fruitful: FMT has emerged as the standard of care for both children and adults when antibiot- ics fail. LOWER COSTS "When we started our FMT program two years ago, many insurance plans wouldn't cover FMT," says David Brumbaugh, MD, Digestive Hea lth Institute physician at Children's Hospita l Colorado a nd Associate Professor of Pediatrics at the University of Colorado School of Medicine. "It was important for us to create a cost- e–ective FMT program because it would be more accessible for patients." Based on outcomes from Children's Hospit a l Colorado's FMT prog ra m, researchers published a retrospective cohort study in The Journal of Pediatrics regarding the cost-e–ectiveness of pedi- atric FMT performed via NGT. They found that this approach costs $1,139 on avera ge. That is approxi- mately 85 percent less than FMT performed via colonoscopy ($7,767) and 78 percent less than FMT via nasoduodenal tube°($4,998). "Primarily with colonoscopy, the big- gest cost addition is anesthesia or the time in a procedural center," says Edwin de Zoeten, MD, PhD, Director of the Inflammatory Bowel Disease Center at Children's Hospital Colorado and Associate Professor of Pediatrics at the University of Colorado School of Medicine. "As for nasoduodenal tubes, they need to be placed by an interventional radiologist, which adds the cost of another physician, more X-ray time and sometimes sedation, especially for younger kids." NGT placement can be performed by a registered nurse in an outpatient setting, further reducing costs. I n a dd it ion , C h i ld ren's Hospit a l Colorado uses a stool donor bank from a standard commercial laboratory instead of family-provided stool samples, lowering average costs associated with stool dona- tion by 46 percent ($1,154 to $628). Donor banks perform testing in bulk, acquiring multiple stools from a single donor that can be used for numerous pro- cedures, similar to the way blood banks acquire and allocate donations. By com- parison, a familial donor undergoes several tests for one procedure on a single patient. "Every familial donor has to be tested for viral and bacterial infections using the proper equipment," Dr. de Zoeten says. "Much of this equipment can't be cleaned and is thrown away [with each donor], which increases the cost." EASE AND EFFICACY NGT procedures are often much less burdensome for patients and their families as well. They take only an hour or two and don't require children to endure the bowel- clearing diarrhea preparation associated with colonoscopies. "Our child life specialists are helpful in getting kids to cooperate and be actively involved with NGT procedures," Dr. de Zoeten says. In terms of effectiveness, the study found that FMT via NGT successfully treated 94 percent of children with CDI who were otherwise healthy, 75 percent of children with complex medical issues and 54 percent of children with inflam- matory bowel disease (IBD). "Chronically ill children, such as solid organ transplant recipients or children with oncologic diagnoses, are medically fragile and may be more likely to get regular courses of antibiotics," Dr. Brumbaugh explains. "This can hamper FMT effi- cacy if prescribed within two°months of the procedure." Children with IBD may also present symptoms of CDI that may not be caused by the C-diff bacteria, which makes it more di•cult for researchers to determine whether IBD or CDI is the cause of the lower success rate for all methods of FMT in children with IBD. The study found FMT via NGT matches the e–ectiveness of colonoscopy and naso- duodenal methods within a few percentage points, aligning with findings from recent research in Bioscience Horizons. Cases that may still necessitate colo- noscopy include those in which a child is predisposed to vomiting, has facial or throat anatomy that would make placement of NGT challenging, or is experiencing inflammation that inhibits the movement of materials in the small bowel and colon. ■ Treating Pediatric C-diff BY JOSH GARCIA A Cost-Effective Approach to 0 8

• Cover