967. Fecal Microbiota Transplantation A Safe and Effective Treatment for Clostridium difficile Infection in Stem Cell Transplantation
Session: Poster Abstract Session: Clostridium difficile Infections: Treatment and Prevention
Friday, October 9, 2015
Room: Poster Hall
Posters
  • FMT in BMT poster.pdf (325.8 kB)
  • Background: Fecal microbiota transplantation (FMT) is highly efficacious and a safe procedure to treat recurrent/refractory Clostridium difficileinfection (CDI). Immunocompromised hosts (IH) including stem cell transplant (SCT) recipients have a higher incidence rate of CDI but only rare case reports describe the use of FMT in these patients. We sought to assess the efficacy and safety of FMT for the treatment of CDI in SCT recipients.

    Methods: A retrospective study was performed in two urban medical centers in Detroit, Michigan from May 2010 to April 2015. Nine SCT recipients with recurrent CDI of moderate to severe intensity, not responding to conventional antibiotic therapy were evaluated by Infectious Diseases and referred for FMT. Data abstracted include demographics, co-morbidities, anti-microbial use, immune suppression, severity and number of CDI episodes. Neutropenic subjects were excluded. Healthy donors were screened for communicable diseases. Using fresh stools from the day of procedure, FMT was performed using a nasogastric (NG) or enema route in the outpatient setting. All patients were followed for at least 100 days post-FMT. 

    Results: Nine SCT recipients (allogeneic 6; autologous 3) received FMT for recurrent CDI during the study period. Median age of the subjects was 56 years (range 43-70). NG route was used to perform FMT in 3 out of 9 patients and enema in the reminder. Resolution of CDI was seen in all patients within 7 days of FMT. By day 100 post-FMT, none of the subjects had any recurrence of CDI. The 30-day all-cause mortality was 0%. No major adverse effect was attributable to FMT. Three of six allogeneic SCT recipients had gastrointestinal graft-versus-host disease (GVHD) at the time of FMT. After FMT, there was no worsening of GVHD and immune suppression was tapered gradually.

    Conclusion: In SCT, FMT is effective in treating recurrent CDI. FMT can be safely performed in the outpatient setting.

    Mayur Ramesh, MD1, Abinav Deol, MD2, Rachna Jayaprakash, MD1, Odaliz Abreu-Lanfranco, MD1, George Alangaden, MD, FIDSA1, Joseph Uberti, MD2, Sanjay Revankar, MD3 and Pranatharthi Chandrasekar, MD, FIDSA3, (1)Infectious Diseases, Henry Ford Health System, Detroit, MI, (2)Karmanos Cancer Institute, Detroit, MI, (3)Infectious Diseases, Detroit Medical Center / Wayne State University, Detroit, MI

    Disclosures:

    M. Ramesh, None

    A. Deol, None

    R. Jayaprakash, None

    O. Abreu-Lanfranco, None

    G. Alangaden, None

    J. Uberti, None

    S. Revankar, Astellas: Investigator , Research grant
    Merck: Investigator , Research grant
    Gilead: Investigator , Research grant

    P. Chandrasekar, Astellas: Speaker's Bureau , Speaker honorarium

    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.