1406. The Effect of Routine Fecal Microbiota Transplantation (FMT) on Healthcare-facility Associated Clostridium difficile Infection: A Mathematical Modeling Approach
Session: Poster Abstract Session: Clostridium difficile
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • SER_FMT.pdf (4.4 MB)
  • Background: Healthcare-facility onset Clostridium difficile infection (CDI) is most frequently caused by disruptions of the intestinal flora. FMT, which transfers fecal flora from healthy donor patients to those with recalcitrant CDI, has shown promising preliminary results. However, studies on the widespread use of FMT as an intervention to prevent recurrent or incident infections in hospitalized patients are lacking.

    Methods: We used a stochastic compartmental model to simulate the routine use of FMT in a 12-bed intensive care unit under four different treatment regimens: 1) The use of FMT in patients after an initial CDI, 2) The use of FMT in patients after the discontinuation of antibiotics, 3) The use of FMT in patients after a discontinuation of antibiotics or proton pump inhibitors or 4) A combination of strategies 1 and 3. All 4 regimens were evaluated for impact on recurrent or incident CDI occurring in patients housed on the unit.

    Results: The use of FMT in patients after initial CDI resulted in a statistically significant (p<0.001) reduction in recurrence but did not have a significant impact on incidence (p=0.35). The use of prophylactic FMT in patients on antibiotics, or antibiotics and proton pump inhibitors did not result in a statistically significant reduction in recurrence (p=0.47 and p=0.97). Both resulted in a statistically significant difference in overall incidence (p=0.004 and p=0.09), though this difference did not decrease in caseload, with identical median, 25th and 75th percentiles of incident cases in the ICU over a simulated year. Finally, the combined intervention using treatment strategies 1 and 3 resulted in a significant difference in recurrence (p<0.001), and incidence (p=0.007) though again the difference in incidence did not manifest as a decrease in the burden of disease within the ICU.

    Conclusion: Modeling results suggest that treating patients diagnosed with CDI with FMT may be an effective means of preventing recurrent infections; however in a single ICU it may not result in an observable decrease in incident CDI. A sustained reduction in caseload may only be observable in the healthcare system as a whole, rather than in single wards. Future modeling studies and randomized trials should take this into account, and may require large, multi-center studies.

    Eric Lofgren, MSPH, PhD, Epidemiology, UNC Gillings School of Global Public Health, Chapel Hill, NC, Rebekah W. Moehring, MD, MPH, Division of Infectious Diseases, Duke University Medical Center, Durham, NC, Deverick J. Anderson, MD, MPH, Duke Infection Control Outreach Network, Duke University Medical Center, Durham, NC, David J. Weber, MD, MPH, FIDSA, FSHEA, Division of Infectious Diseases, University of North Carolina At Chapel Hill, Chapel Hill, NC and Nina Fefferman, PhD, Ecology, Evolution and Natural Resources, Rutgers University, New Brunswick, NJ

    Disclosures:

    E. Lofgren, None

    R. W. Moehring, None

    D. J. Anderson, None

    D. J. Weber, Pfizer: Consultant and Speaker's Bureau, Consulting fee and Speaker honorarium
    Merck: Consultant and Speaker's Bureau, Consulting fee and Speaker honorarium

    N. Fefferman, None

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