966. Implementation and outcomes of Fecal Microbiota Transplantation in a Four Hospital System
Session: Poster Abstract Session: Clostridium difficile Infections: Treatment and Prevention
Friday, October 9, 2015
Room: Poster Hall
Posters
  • Fecal Transplant poster IDSA 10.7.15.pdf (708.0 kB)
  • Background: Incidence of Clostridium difficile infection (CDI) in the United States in 2011 was 453,000.  Despite antimicrobial treatment, recurrence rate of CDI is 20%, with 45% of patients having a second recurrence.  The Gastroenterology Guidelines recommend FMT for third occurrence after failure of pulsed vancomycin therapy.  At present time the Food Drug and Administration (FDA) requires informed consent for all FMT procedures for CDI.  The current average cure rate with use of FMT for CDI is greater than 90%. We evaluated use of FMT for recurrent CDI in a four hospital system.

    Methods: Concurrent and retrospective analysis of 24 patients from December 2011 through May 2015.  Data collection included demographics, date of each positive CDI, antibiotics used up to 3 months prior to first episode, length of stay, 30 day mortality rate, type of FMT procedure utilized and type of donor stool investigated ( commercial vs related donor).

    Results: Mean age for FMT was 71 years old and 54% female.  Most common method of FMT administration was colonoscopy (71%) followed by endoscopy (17%) and nasogastric tube (12%).  Related donor was the most common donor type at 63% followed by OpenBiome , commercialized stool bank product, at 37%.  Nineteen (79%) of the patients were using multiple antibiotics prior to FMT which included cephalosporin (29%), fluoroquinolone (26%), penicillin (15%), macrolide (9%), monobactam (3%), and tetracycline (3%). Of the 24 patients, 5 (21%) relapsed and 2 patients had repeat FMT, one of which received two repeat FMT procedures. One of the five CDI relapse patients had antibiotic use prior to relapse, while other four had unclear cause.  

    Conclusion: Effective FMT was defined as no recurrence of CDI, or those with recurrence, cause was an inciting event such as antibiotics.  Effective FMT was seen in 20 of 24 (83%) of the patients.  There was a 22% recurrence rate of CDI post FMT, with 1 patient with multiple recurrences.  Majority of patients (79%) received antibiotics within 3 months prior to CDI.  There was no mortality 30 days post FMT (3 excluded because have not seen data out 30 days).  FMT shows promise in preventing recurrent CDI infections and prospective analysis of efficacy, safety, cost, and timing would be valuable to CDI prevention in the future.

    Adrienne Kercsak, PharmD, Eva Sullivan, PharmD and Harminder Sikand, PharmD, FCSHP, FASHP, Scripps Mercy Hospital, San Diego, CA

    Disclosures:

    A. Kercsak, None

    E. Sullivan, None

    H. Sikand, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 7th with the exception of research findings presented at the IDWeek press conferences.