533. Scaling Pediatric Access to Fecal Microbiota Transplantation in the United States: A Time-series Geospatial Analysis
Session: Poster Abstract Session: Healthcare Epidemiology: Updates in C. difficile
Thursday, October 4, 2018
Room: S Poster Hall
Posters
  • Final Poster_Upload_PratikPanchal.pdf (2.5 MB)
  • Background:

    The rising prevalence of recurrent Clostridium difficile infection (CDI) in pediatrics is a public health concern. Fecal microbiota transplantation (FMT) is an effective treatment and is recommended in U.S. guidelines. Universal stool banks (USB) have enabled widespread FMT access among adult patients, however the progression of FMT uptake in pediatrics is unknown. We present a geospatial timeseries analysis of growth in pediatric FMT providers within the U.S. between 2013 and 2018.

    Methods:

    A list of healthcare facilities associated with a USB and a FMT special interest group was geocoded using Google Maps. Spatial network analysis methods were used to create drive-time polygons for each healthcare facility with simulated traffic for 12 pm on a Wednesday. US Census data was used to estimate the percentage population living within 1, 2, and 4-hour drive time to a pediatric FMT provider cumulatively from 2013 to March 2018.

    Results:

    Between 2013 and 2018 there was a rapid expansion in access to FMT to include 45 pediatric healthcare facilities (Figure 1). As of March 2018, 40.51% of the US population lives within a 1-hour drive, 62.73% within a 2-hour drive, and 89.38% within a 4-hour drive of an FMT provider (Table 1). The largest percentage increases in access occurred between 2013 and 2014 (28.43% increase within a 1-hour drive time). These 45 FMT providers include 6 community hospitals, 7 private practices and 32 academic centers.

    Conclusion:

    Although these results demonstrate a rise in pediatric FMT providers across the U.S., there remains a significant discrepancy in access between adult and pediatric populations, despite growing evidence of safety and efficacy of FMT. Additional efforts are needed to address barriers to FMT and improve access for pediatric patients with recurrent CDI.

    Table 1: Pediatric FMT facilities within a 1, 2 and 4-hour drive time

    Year

    No. of Partners

    Time (hours)

    % of US Population

    2013

    10

    1

    17.74

    2

    28.28

    4

    44.09

    2014

    15

    1

    22.79

    2

    36.88

    4

    60.74

    2015

    23

    1

    28.54

    2

    45.54

    4

    70.17

    2016

    33

    1

    34.14

    2

    55.23

    4

    79.57

    2017

    41

    1

    39.20

    2

    61.26

    4

    88.76

    2018

    45

    1

    40.51

    2

    62.73

    4

    89.38

    Figure 1: Pediatric Access to FMT from 2013-2018

    Pratik Panchal, MD MPH1,2, Stacy Kahn, MD3, Caroline Zellmer, BS1, Zain Kassam, MD MPH1,4, Majdi Osman, MD MPH1, Jessica Allegretti, MD, MPH5, Monica Seng, AB1, Shrish Budree, MD1,6 and NASPGHAN FMT Special Interest Group, (1)OpenBiome, Somerville, MA, (2)Global Health & Population, Harvard University T.H. Chan School of Public Health, Boston, MA, (3)Boston Children's Hospital, Boston, MA, (4)Finch Therapeutics, Somerville, MA, (5)Gastroenterology, Brigham and Women's Hospital, Boston, MA, (6)Pediatrics, University of Cape Town, Cape Town, South Africa

    Disclosures:

    P. Panchal, OpenBiome: Employee , Salary .

    S. Kahn, None

    C. Zellmer, None

    Z. Kassam, None

    M. Osman, None

    J. Allegretti, None

    M. Seng, None

    S. Budree, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 3rd with the exception of research findings presented at the IDWeek press conferences.