109. Differences in Gram-Negative Antibiotic Susceptibility Among Patients Receiving Fecal Microbiota Transplant for Clostridioides difficile

Abstract

BackgroundDecreases in multidrug-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.MethodsWe retrospectively reviewed the available microbiology results for patients who underwent FMT for recurrent Clostridioides difficile infection (RCDI) at Emory University from July 7, 2012 until December 2017 and had microbiology results within 1 year pre- and post-FMT. Demographic and clinical characteristics were abstracted by trained reviewers, and statistical tests of differences in central tendency were tested with Wilcoxon signed-rank tests.ResultsOf 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, and 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. Although 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. ion of viral quantitative PCR results did not suggest clinical recognition of new infection or reactivation of viruses after FMT.ConclusionFMT 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.Disclosures All authors: No reported disclosures.