109. Differences in Gram-Negative Antibiotic Susceptibility among Patients Receiving Fecal Microbiota Transplant for Clostridioides difficile
Session: Oral Abstract Session: Healthcare Epidemiology: Hot Topics
Thursday, October 4, 2018: 8:45 AM
Room: S 157

Background: Decreases in multi-drug resistant organism (MDRO) colonization and antibiotic resistance gene abundance have been reported after fecal microbiota transplantation (FMT) but data on clinical microbiology culture and susceptibility results after FMT are limited.

Methods: We retrospectively reviewed the available microbiology results for patients who underwent FMT for recurrent Clostridioides difficile infection (RCDI) at Emory University from 7/2012 until 12/2017 and had microbiology results within 1 year pre and post FMT. Demographic and clinical characteristics were abstracted by trained reviewers, statistical tests of differences in central tendency were tested with Wilcoxon signed-rank tests.

Results: Of 236 unique patients undergoing FMT during the study period, 18 had growth of Gram-negative bacteria on culture pre and post FMT. Of these, 8 had Gram-negative growth in urine culture (the most common site) pre and post FMT. Fourteen (14/18, 78%) patients were female, 4/18 (22%) were black, 14/22 (78%) were white, 18/18 (100%) were non-Hispanic. The mean number of CDI episodes prior to first FMT was 4 (range 3-7 episodes). Differences in counts of susceptible, intermediate, and resistant susceptibility test results before and after FMT are shown in Figures 1 and 2. Though a trend in reduction of resistant reports is visually suggested, this was not statistically significant by Wilcoxon signed-rank testing (p= 0.10 for all cultures, p=0.21 for urine). Ten patients had pre-FMT micro results and no micro results after FMT but reduction of count of infectious syndromes in FMT could not be tested with this study design. Abstraction of viral quantitative PCR results did not suggest clinical recognition of new infection or reactivation of viruses after FMT.

Conclusion: FMT may reduce clinical burden of antimicrobial resistance but statistically significant differences in resistance were not detected in this study. Further study with RCTs is needed.

Figure 1: Gram Negative Culture Results from all sites within 1 year pre and post FMT, 2012-2017.



Figure 2: Gram Negative Urine Culture Results within 1 year pre and post FMT, 2012-2017.

Michael Woodworth, MD, MSc1, Tiffany Wang, MD2, Divyanshu Raheja, MPH2, Alex Waldman, BS2, Rachel Friedman-Moraco, MD1, Allen Graham, BA3, Tanvi Dhere, MD4 and Colleen Kraft, MD, MSc1,3, (1)Medicine, Division of Infectious Disease, Emory University School of Medicine, Atlanta, GA, (2)Emory University School of Medicine, Atlanta, GA, (3)Pathology, Emory University School of Medicine, Atlanta, GA, (4)Division of Digestive Diseases, Emory University School of Medicine, Atlanta, GA


M. Woodworth, None

T. Wang, None

D. Raheja, None

A. Waldman, None

R. Friedman-Moraco, None

A. Graham, None

T. Dhere, None

C. Kraft, None

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