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.
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.
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.
A. E. Bacon III,
M. Filippone, None
C. Herdman, None
S. Myerson, None
M. Drees, None
A. Panwalker, None
C. Duffalo, None
R. Bowling, None
P. Mcgraw, None
See more of: Poster Abstract Session