2119. Clearance of Vancomycin-Resistant Enterococcus Colonization with Fecal Microbiota Transplantation among Patients with Recurrent Clostridium difficile Infection
Session: Poster Abstract Session: Clostridium difficile: Therapeutics
Saturday, October 29, 2016
Room: Poster Hall
Background: Vancomycin-resistant enterococcus (VRE) is a public health threat to hospitalized patients and gastrointestinal colonization with VRE is a major risk factor for active infection, including bacteremia. Fecal microbiota transplantation (FMT) is a well-tolerated and effective treatment for recurrent C. difficile (rCDI). Data from animal models and clinical case reports suggest that FMT may reverse dysbiosis and eliminate colonization with antibiotic-resistant organisms, including VRE; however there is a paucity of clinical data. This study aims to determine whether FMT may decolonize VRE in rCDI patients treated with FMT.

Methods: A multicenter retrospective analysis was performed using stool samples from rCDI patients treated with FMT (n=31) or autologous FMT as a control (n=18). Material was accessed from 6 academic hospitals under existing research protocols. VRE was assessed using a PCR-based assay targeting VanA (Acuitas® MDRO Gene Test). Colonization was defined as positive result at any dilution. VRE decolonization was defined as absence of VRE colonization post-FMT among a patient colonized with VRE pre-FMT.

Results: Among the cohort, 9/31 (29%) of patients in the FMT group and 7/18 (39%) of patients in the control group were colonized with VRE at baseline. At the first time point measured post-FMT, 9/9 (100%) of colonized patients in the FMT group tested VRE-negative compared to 3/7 (43%) in the control group (p=0.02, Fisher's Exact Test). On subgroup analysis, samples collected at ≤6 weeks, 5/5 (100%) patients in the FMT group and 3/7 (43%) controls were decolonized; for samples collected at >6 weeks, 4/4 (100%) in the FMT group and 6/7 (86%) in the control group were decolonized. These results from subgroup analyses were not statistically significant given the high rate of spontaneous VRE decolonization.

Conclusion: FMT may be able to eliminate gastrointestinal colonization with VRE. However, a well-powered RCT with short follow-up time points is necessary to prospectively examine colonization dynamics and clinical outcomes. These results from a heterogeneous retrospective cohort study suggest that FMT or related microbial therapies may be effective to prevent infection and transmission of VRE in high-risk settings.

Lindsay Eysenbach, AB1, Jessica R. Allegretti, MD, MPH2,3, Olga Aroniadis, MD4, Lawrence Brandt, MD4, Danyel Donovan, BS5, Monika Fischer, MD, MSCR6, Ari Grinspan, MD7, Zain Kassam, MD MPH1, Colleen R. Kelly, MD8, Christina Kim, BS1, Casey Morrow, PhD9, Majdi Osman, MD MPH1, Julia Quan, BS5, Martin Rodriguez, MD, FIDSA9, Terry Walker, PhD5 and Mark Smith, PhD1, (1)OpenBiome, Medford, MA, (2)Harvard Medical School, Boston, MA, (3)Brigham and Women's Hospital, Boston, MA, (4)Montefiore Medical Center, Bronx, NY, (5)OpGen, Gaithersburg, MD, (6)Indiana University, Indianapolis, IN, (7)Icahn School of Medicine at Mount Sinai, New York, NY, (8)The Warren Alpert Medical School of Brown University, Providence, RI, (9)University of Alabama at Birmingham, Birmingham, AL

Disclosures:

L. Eysenbach, OpenBiome: Employee , Salary

J. R. Allegretti, OpenBiome: Collaborator and Scientific Advisor , Research support

O. Aroniadis, OpenBiome: Collaborator , Research support

L. Brandt, OpenBiome: Collaborator , Research support
Crestovo: Scientific Advisor , Compensation

D. Donovan, OpGen: Employee , Salary

M. Fischer, Openbiome: Collaborator , Research support
Rebiotix: Consultant , Compensation

A. Grinspan, Seres Therapeutics: Investigator , Compensation

Z. Kassam, OpenBiome: Employee , Salary
Finch Therapeutics: Consultant and Shareholder , Equity and Research support

C. R. Kelly, None

C. Kim, OpenBiome: Employee , Salary

C. Morrow, None

M. Osman, OpenBiome: Employee , Salary

J. Quan, OpGen: Employee , Salary

M. Rodriguez, None

T. Walker, OpGen: Employee , Salary

M. Smith, OpenBiome: Employee , Salary
Finch: Board Member , Employee and Shareholder , Equity and Salary

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