90. Fecal Microbial Transplantation: Highly Effective Treatment for Severe Clostridium difficile Infection
Session: Oral Abstract Session: New Considerations in C. difficile Prevention and Treatment
Thursday, October 3, 2013: 9:30 AM
Room: The Moscone Center: 300
Background: Severe Clostridium difficile infection (CDI) has markedly increased. Age>60 years and multiple co-morbidities are positive predictors for poor CDI outcome. The purpose of this pilot study was to evaluate fecal microbial transplantation (FMT) in patients failing C. difficile antibiotic treatment.

Methods: Hospitalized FMT recipients (n=21) had: >3 watery stools or >200 ml/day output from ostomy, tested positive by C. difficile toxin B PCR or toxin A/B EIA, and were deteriorating clinically while on oral vancomycin +/- intravenous metronidazole. Suitable recipients weren't neutropenic, or on chemo/radiation therapy. Low risk donor blood and stool were tested for pathogens. A dedicated, screened donor (17/21) was used if no other available suitable donor. Fresh, filtered stool was used for transplantation, and was introduced via nasogastric tube followed by two rectal retention enemas. Signed, informed consent was obtained from all recipients or proxies. Enteritis and colitis were verified by computerized abdominal  tomography, and pseudomembranous colitis by colonoscopy if needed.

Results: Recipient characteristics are in Table 1. There were no adverse events related to transplant, and cure at 30 days was 20/21 (95.2%). Relationship of FMT attempts vs: Horn Index (p=0.12721, X2=5.700,3), disease severity (more attempts p=0.0419, X2=6.343,2), and GI surgery  (p=0.1473 X2=2.100,1). Increased age was related to increased diarrhea duration (p=0.0418 X2=32.15,20).

 Table 1. Recipient Characteristics

Variable

Value

Gender(%)      Male

10 (47.6)

                       Female

11 (52.4)

Age (yr)

70.9+11.9 (36-85)2

Horn Index3         1

1

                            2

6

                            3

10

                            4

4

Disease Severity4

 

                            1

7

                            2

4

                            3

10

Diarrhea Duration    (days)                    

2+1.2 (1-5)2

GI Surgically Altered (%)5

5/21 (23.8)

FMT Attempt(%) Once

14 (66.6)

                      Twice                          

 7  (33.4)

1 p<0.05 is significant; 2Mean+SD (range); 3Modified Horn Index: 1-mild, 2-moderate, 3-severe, 4-extremely severe co-morbidities; 4 Disease severity: 1-diarrhea alone, 2-colitis, 3-sepsis+ diarrhea, colitis, enteritis or PMC; 5 GI Surgery-3/5 subtotal colectomy, and 2/5 other surgery.

Conclusion: FMT of hospitalized patients with severe CDI, multiple co-morbidities, advanced age, and surgically altered gastrointestinal tracts, is safe and efficacious for those failing conventional CDI treatment. The data suggest that FMT should be evaluated as a primary treatment in these patients.

Linda Bobo, MD, PhD, Infectious Diseases, Southern Illinois Healthcare/Medical Service, Carbondale, IL, Erica Kaufman, MD, Infectious Diseases, Southern Illinois Healthcare/Medical Services, Carbondale, IL and Diana Biggs, MT, ASCP, SM, Clincal Laboratory, Southern Illinois Healthcare, Herrin, IL

Disclosures:

L. Bobo, None

E. Kaufman, None

D. Biggs, None

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