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Early-life microbial colonization plays a key role in future health. In this issue of Cell Host & Microbe, Bogaert et al. unravel the complexities of mother-infant microbial seeding by examining multiple maternal and infant niches. Importantly, they describe “auxiliary” seeding pathways that may partially compensate when seeding patterns are perturbed.

Background & Aims Fecal microbiota transplantation (FMT) is commonly used to treat Clostridium difficile infection (CDI). CDI is an increasing cause of diarrheal illness in pediatric patients, but the effects of FMT have not been well studied in children. We performed a multi-center retrospective cohort study of pediatric and young adult patients to evaluate the efficacy, safety, and factors associated with a successful FMT for the treatment of CDI. Methods We performed a retrospective study of 372 patients, 11 months to 23 years old, who underwent FMT at 18 pediatric centers, from February 1, 2004, to February 28, 2017; 2-month outcome data were available from 335 patients. Successful FMT was defined as no recurrence of CDI in the 2 months following FMT. We performed stepwise logistic regression to identify factors associated with successful FMT. Results Of 335 patients who underwent FMT and were followed for 2 months or more, 271 (81%) had a successful outcome following a single FMT and 86.6% had a successful outcome following a first or repeated FMT. Patients who received FMT with fresh donor stool (odds ratio [OR], 2.66; 95% CI, 1.39–5.08), underwent FMT via colonoscopy (OR, 2.41; 95% CI, 1.26–4.61), did not have a feeding tube (OR, 2.08; 95% CI, 1.05–4.11), or had 1 less episode of CDI before FMT (OR, 1.20; 95% CI, 1.04–1.39) had increased odds for successful FMT. Seventeen patients (4.7%) had a severe adverse event during the 3-month follow-up period, including 10 hospitalizations. Conclusions Based on the findings from a large multi-center retrospective cohort, FMT is effective and safe for the treatment of CDI in children and young adults. Further studies are required to optimize the timing and method of FMT for pediatric patients—factors associated with success differ from those of adult patients.

understanding of the relationships between the intestinal microbiota and disease development. By enrolling twin pairs (n=14) in our study, we found a difference in bacterial families of intestinal microbiota composition (0-12 months) existed in dizygotic twins although they lived in the same environment. Among infants from twin (n=14) or singleton (n=7) pregnancy, the initial colonizer was restricted to bacteria from Proteobacteria (Escherichia/Shigella or Sphingopyxis) and Firmicutes (Bacillus or Staphylococcus). During the study period, 52.4% of these subjects developed allergic symptoms, mainly nasal and skin manifestations. Most importantly, we found a distinctive feature of gut microbiota pattern in allergic infants (n= 11) as compared with the healthy babies (n=10). The former harbored relative abundance of Firmicutes bacteria, particularly those from families Clostridiaceae and Lachnospiraceae of Firmicutes. Increasing Clostridiaceae in allergic subjects (72.7%) was observed from 1st to 6th month after birth, and thereafter declined gradually to an undetectable level at 12th month ; whereas the presence of Clostridiaceae in healthy babies was maintained in low frequency from 1st to 12thmonths (p

Background: Clostridium difficile infection (CDI) is the leading cause of nosocomial diarrhea in the USA and is increasing in prevalence. Evidence from the adult literature has demonstrated that patients with inflammatory bowel disease (IBD) have a higher prevalence of CDI than the general population. There is a paucity of literature regarding CDI in pediatric patients with IBD, which may differ from adults. The prevalence of CDI in hospitalized pediatric IBD patients compared with adult IBD patients is unknown. Aim: To compare the prevalence of CDI in hospitalized pediatric IBD patients, adult IBD patients and hospitalized patients without IBD. Methods: The rates of CDI per 1,000 hospitalizations for patients with and without IBD in the state of Maryland between 1993 and 2011 were examined using the Maryland Health Services Cost Review Commission database. ICD-9-CM codes in any diagnostic position for CDI (008.45), ulcerative colitis (UC; 556) and Crohn's disease (CD; 555) were used to identify hospitalizations. A hospitalization without a code for 555 or 556 was considered a non-IBD hospitalization. Pediatric patients were defined as less than 18 years of age on admission. Incidence rate ratios with robust variances comparing CDI in pediatrics and adults by type of IBD and with patients without IBD were calculated for all years and the most recent year using Stata 11. Results: Among patients with IBD, the rate of CDI was 30.5 per 1,000 hospitalizations compared with 7.8 per 1,000 hospitalizations in patients without IBD (p,0.001). Among adults, the rate of CDI was 3 times greater in IBD hospitalizations than non-IBD hospitalizations (p,0.001) and among pediatric patients, the rate of CDI was over 20 times greater in IBD than non-IBD hospitalizations (p,0.001). In 2011, children with CD had a 2.5 times greater rate of CDI than adults with CD (p,0.001). In 2011, children with UC had a 44% decreased rate of CDI than adults with UC (p=0.01). There was no difference in the rate of CDI between pediatric CD and UC during 1993-2011 (p=0.39). However, in 2011, pediatric CD patients had a 3.5 times greater rate than pediatric UC patients (p,0001). Conclusions: Our study shows that hospitalized children with IBD have a significantly greater prevalence of CDI than hospitalized children without IBD. Moreover, children with CD have a greater rate of CDI during hospitalization than adults with CD, although the opposite is true with UC, potentially suggesting different risk factors for CDI in the pediatric IBD population.