964. Development of A Fecal Microbiota Transplant (FMT) Program for Relapsing Clostridium difficile Disease(CDAD)
Session: Poster Abstract Session: Clostridium difficile Infections: Treatment and Prevention
Friday, October 9, 2015
Room: Poster Hall
Background: Management of Fecal Microbiota Transplant (FMT) for relapsing Clostridium difficile associated disease (CDAD) will require oversight for years to come as we learn about the efficacy, complications, potential pitfalls and future health concerns of the patients undergoing this new intervention.We describe the development of a FMT program that was established in order  to track indications, complications, failures and future health developments in the patients undergoing this treatment.

Methods: Committee of Physicians (GI,ID) and hospital support developed strict criteria for FMT candidates,donor stool acquisition, and protocol driven assessment during the pre FMT and post FMT timeframe. Approval by ID and GI required .Four GI physicians permitted  to perform FMT.

FMT criteria: At least 2 CDAD relapses, failed vancomycin taper regimen ,no bowel disease

Failed FMT: Recurrent CDAD requiring treatment

Registry: Patients interviewd pre FMT. weekly phone contact  x 4 weeks, monthly,  3 months, 6 months and 1 year.

Cost data : Institutional direct cost including GI suite, anesthesia, labor, equipment and donor stool (OpenBiome , Boston, MA). GI physician billing records reviewed

Data collected: Time of pre FMT vancomycin discontinuation, bowel prep (Boston Bowel Prep score ),  retention time  FMT, time to normal stool.

Results:

Between April 2014 and April 2015 17 patients have undergone FMT . Prior to FMT ,patients reported between 2 and  >12 relapses. 5 (29%)  failed FMT with recurrent disease developing  from day 6 to 33 post procedure. An additional patient had recurrence in 10 months, after antibiotic use. Reasons assessed for failure include abnormal anatomy (1), poor bowel prep(2) and inability to retain donor stool (2). 11 patients have been followed for 6 months post transplant and report no adverse events or health changes.1 patient expired from comorbid disease and 1 was lost to follow up. Direct costs for the 11 procedures averaged $726. Insurance covered all 11 procedures including physician fees with limited out of pocket expense.

Conclusion:

1) FMT appears to be a cost effective intervention in relapsing CDAD

2) FMT was well tolerated and  efficacious in patients with relapsing CDAD

3) A structured program is useful in documenting efficacy,acceptability and feasibility of performing FMT.

Alfred E. Bacon III, MD, Fedele Depalma, MD, Marcianna Filippone, MD, Christine Herdman, MD, Scott Myerson, MD, Marci Drees, MD, MS, Anand Panwalker, MD, FIDSA, Chad Duffalo, MD, Richard Bowling, CPA MBA and Patty Mcgraw, RN, MS, Christiana Care Health System, Newark, DE

Disclosures:

A. E. Bacon III, None

F. Depalma, None

M. Filippone, None

C. Herdman, None

S. Myerson, None

M. Drees, None

A. Panwalker, None

C. Duffalo, None

R. Bowling, None

P. Mcgraw, None

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