Washed microbiota transplantation in a malnourished child with resistant Klebsiella and Candida infections

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Frontiers in Medicine Published April 23, 2026 Medically reviewed May 25, 2026 DOI ↗ By Dr. Sofia Müller, MD · Lifespan & Whole-Person Care

Key Takeaway

Consider WMT only as an adjunct in comprehensive care for refractory infections, noting this is a single-case observation.

This is a single case report of an 8-year-old boy hospitalized with chronic malnutrition, multidrug-resistant Klebsiella pneumoniae infection, and Candida tropicalis infection, associated with recurrent severe pneumonia and an underlying central nervous system disorder. The intervention was washed microbiota transplantation (WMT) administered via nasojejunal tube in two treatment courses as part of a multimodal salvage strategy; no comparator was reported.

The main results included progressive clinical improvement during continued antimicrobial therapy, respiratory support, and nutritional rehabilitation. The patient's weight increased from 14.0 to 22.5 kg. Subsequent sputum culture results were negative, pulmonary inflammation resolved radiographically, and functional recovery was marked. No specific effect sizes, p-values, or confidence intervals were reported.

Safety and tolerability were not reported; no adverse events, serious adverse events, or discontinuations were noted. Key limitations include the single-case design, concurrent multiple interventions, lack of pre- and post-WMT microbiome sequencing, and the inability to attribute improvement exclusively to WMT. This is an exploratory clinical observation, not confirmatory evidence.

Practice relevance is restrained: WMT may have potential adjunctive value as part of comprehensive management for severely malnourished children with refractory multidrug-resistant pulmonary bacterial and fungal infections, but results are not generalizable and no causal relationship is established.

Study Details

Study typeCohort

EvidenceLevel 3

PublishedApr 2026

View Original Abstract ↓

BackgroundMultidrug-resistant (MDR) Klebsiella pneumoniae and fungal coinfection in children with severe malnutrition are difficult to control with antibiotics alone. This report describes an 8-year-old boy whose pulmonary infection remained uncontrolled and whose nutritional status progressively deteriorated. Washed microbiota transplantation (WMT) was introduced as part of a multimodal salvage treatment strategy, after which the patient showed gradual improvement during continued antimicrobial therapy, respiratory support, and nutritional rehabilitation.Case presentationWe report the case of an 8-year-old boy with chronic malnutrition and recurrent severe pneumonia associated with an underlying central nervous system disorder. He developed recurrent respiratory failure and a persistent pulmonary infection caused by ESBL-producing MDR K. pneumoniae and Candida tropicalis. Despite broad-spectrum antimicrobial therapy, respiratory support, bronchoscopy/bronchoalveolar lavage, and enteral nutrition through a nasojejunal tube, infection control remained poor and nutritional status continued to deteriorate, complicated by sepsis and antibiotic-associated diarrhea. In this context, WMT was introduced through a nasojejunal tube as part of a multimodal salvage treatment strategy and was administered in two treatment courses. Thereafter, during continued antimicrobial treatment, respiratory support, and nutritional rehabilitation, the patient showed progressive clinical improvement, with subsequent negative sputum culture results, gradual radiographic resolution of pulmonary inflammation, weight gain from 14.0 to 22.5 kg, and marked functional recovery.ConclusionThis case suggests that, in severely malnourished children with refractory multidrug-resistant pulmonary bacterial and fungal infections, WMT may have potential adjunctive value as part of comprehensive management. However, because multiple interventions were implemented concurrently and no pre- and post-WMT microbiome sequencing was performed, the observed clinical improvement could not be attributed exclusively to WMT. Therefore, this case should be interpreted only as an exploratory clinical observation rather than confirmatory evidence, and future prospective studies under strict ethical oversight need to be conducted.