2117. Factors Associated With Clostridium Difficile Infection Relapse in Patients after Fecal Microbiota Transplant
Session: Poster Abstract Session: Clostridium difficile: Therapeutics
Saturday, October 29, 2016
Room: Poster Hall
Posters
  • Hartmann_3579483_35x72_.pdf (69.4 kB)
  • Background: Fecal Microbiota Transplantation (FMT) is emerging as a viable treatment option in the management of patients with either severe refractory clostridium difficile infection (CDI) or multiple relapses. FMT has success rate of 89-91%, with a relapse rate of 9-11%. The study aims to identify factors associated with relapse following FMT for the treatment of refractory CDI

    Methods: Retrospective case-control study of patients who underwent FMT at a tertiary institution from January 2011 through September 2014. Patients were divided between success or failure following FMT. Data pertaining to patient demographics, antibiotic therapy for clostridium difficile infection, index antibiotic, steroid use, other immunosuppressants, proton pump inhibitors, presence of inflammatory bowel disease, relapses, and FMT technique were compared between the groups. Antibiotic therapy included in the study were metronidazole, oral vancomycin, vancomycin taper, fidaxomycin, rifaximin and nitazoxanide

    Results: 109 patients were included in the analysis; 10 were cases (patients who relapsed following FMT) and 99 were controls (patients who were successfully treated with FMT). Patients in the case group were treated with metronidazole 9 (90%), vancomycin 9 (90%), fidaxomicin 5 (50%), rifaximin 2 (20%) and vancomycin taper 6 (60%). Treatment in the control group included metronidazole 84 (84.8%), vancomycin 99 (100%), fidaxomicin 27 (27.3%), rifaximin 16 (16.2%) and vancomycin taper 83 (83.8%). Factors including the index antibiotic, use of steroids, other immunosuppressants, proton pump inhibitors, presence of inflammatory bowel disease were analyzed and were not found to be statistically significant. Delivery site of transplanted stool, volume, weight of stool used, and endoscopist performing the procedure also did not affect outcomes. In multivariable analysis, only significant variable was oral vancomycin taper at OR=0.148 [95% CI: 0.029, 0.753]; p=0.021. (table 1). There was an 85% risk reduction in patients who received vancomycin taper compared to those who did not.

    Conclusion: Patient who had a vancomycin taper had a lesser chance (85% reduction in risk) of a relapse following FMT.

    Table: 1 - Vancomycin taper and outcome after FMT
    Case Control Total p Value
    Vancomycin taper p=0.021
    No 4 (40.0%) 16 (16.2%) 20 (18.3%)
    Yes 6 (60.0%) 83 (83.8%) 89 (81.7%)

    Carlos Hartmann, MD, Mayo clinic Arizona, Phoenix, AZ, Sorcha Allen, MD, Mayo Clinic AZ, phoenix, AZ, Cheryl Griesbach, RN, Clinical Studies Unit-Phoenix, Mayo Phoenix, Phoenix, AZ, Heidi Kosiorek, MS, Mayo Clinic AZ, Phoenix, AZ, Robert Orenstein, DO, FIDSA, Infectious Diseases, Mayo Clinic Arizona, Phoenix, AZ and Roberto Patron, MD, Infectious Diseases Division, Mayo Clinic, Phoenix, AZ

    Disclosures:

    C. Hartmann, None

    S. Allen, None

    C. Griesbach, None

    H. Kosiorek, None

    R. Orenstein, Rebiotix Inc.: Investigator and Scientific Advisor , Consulting fee and Research support

    R. Patron, 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.