2116. Inpatient Fecal Microbiota Transplant for Severe and Complicated Clostridium difficile Infections 
Session: Poster Abstract Session: Clostridium difficile: Therapeutics
Saturday, October 29, 2016
Room: Poster Hall
Posters
  • FMT for Severe and complicated CDI final.pdf (500.7 kB)
  • Background: 

    The incidence of severe and complicated Clostridium difficile infection is increasing with associated increase in economic and mortality burden. Antibiotics continue to be first line therapy, with some patients requiring colectomy. Fecal Microbiota Transplant (FMT) has not been rigorously evaluated in severe cases but some studies have shown promising results. We report our experience with FMT in patients with severe/complicated CDI.

    Methods: 

    From 2013-2016, non-surgical candidates who had severe or complicated CDI at UAB Hospital, and were failing standard antimicrobial therapy underwent evaluation for FMT. CDI therapy was continued until FMT. Patients were transplanted a mix of donor feces and normal saline (50-60 cc for nasogastric (NG) tube, 200-300cc for lower endoscopy or enema). Systemic antibiotics were then stopped if clinically appropriate.

    Results:

    A total of 8 patients had inpatient FMT’s from 2013-2016. Seven patients had at least one comorbidity, and four were immunocompromised. All failed oral vancomycin and seven failed combination therapy with metronidazole. Five cases were complicated CDI and were in the ICU at time of FMT. The remaining three were classified as severe. Four were transplanted through NG, two by enema, one by colonoscopy, and one by flexible sigmoidoscopy. Two patients who received NG transplant received concurrent transplant via enema. No adverse events were recorded. 3/8 patients were cured with initial transplant, 3/8 relapsed but were cured with repeat FMT’s and 2/8 died.

    Conclusion: 

    FMT for severe CDI is not currently first line therapy. However, our preliminary data shows an eventual success rate of 75% in a severely ill patient population with many co-morbidities. Further studies in severe and complicated disease are needed to define efficacy and optimal delivery methods for FMT.

    Jeremey Walker, M.D., Internal Medicine, University of Alabama at Birmingham, Birmingham, AL, Martin Rodriguez, MD, FIDSA, Medicine, University of Alabama at Birmingham, Birmingham, AL and Nathan Gundacker, MD, Infectious Disease, University of Alabama at Birmingham, Birmingham, AL

    Disclosures:

    J. Walker, None

    M. Rodriguez, None

    N. Gundacker, None

    Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.