2817 Efficacy of Fecal Microbial Transplant in Treatment of Recurrent Clostridioides difficileInfection in Community Hospitals in Las Vegas

Abstract

INTRODUCTION: Fecal microbial transplant (FMT) has been established as an effective treatment for recurrent Clostridioides difficile infection (CDI); however, current treatment guidelines for recurrent CDI in the community hospital setting remain unclear. Recurrence is defined as resolution followed by recurrence of CDI symptoms within 2-8 weeks after discontinuing antibiotic treatment. Recurrent CDI is seen in 10-25% of patients most commonly within 30 days but up to 2 months after completion of antibiotic therapy. In 2013, a randomized control trial demonstrated 81% response rate to FMT therapy for recurrent CDI versus 31% with vancomycin alone. The goal of our study was to evaluate the efficacy of FMT as a treatment modality for recurrent CDI in the community hospital setting. METHODS: In a retrospective data collection study, 27 patients diagnosed with 2 or more recurrences of CDI were selected for cecal infusion of FMT at 3 different community hospitals in Las Vegas between March 2017 and December 2018. Donor feces were obtained from OpenBiome and prepared according to the manufacturer’s instructions. Patients were screened for HIV, HAV, HBV, HCV and enteric bacterial pathogens. Antibiotics were discontinued 24-48 hours prior to FMT. All patients underwent bowel preparation with 4 liters polyethylene glycol. 250 cc of donor feces was delivered into the cecum via colonoscopy. Patients were re-evaluated at 8-weeks follow-up visits. RESULTS: Of the 27 patients treated with cecal infusion of FMT, 18 were available for 8-weeks follow-up evaluations. 14 of these patients reported complete resolution of CDI symptoms without recurrence. 3 patients had refractory CDI. 1 patient had persistent diarrhea due to Crohn’s disease. 1 patient died of septic shock during a hospital readmission. 8 patients were lost to follow-up. CONCLUSION: This study demonstrated FMT was effective in 78% of patients with recurrent CDI in community hospitals. Of the 3 patients with refractory CDI, 1 responded to a second FMT, 1 failed two additional FMTs but ultimately responded to an extended course of vancomycin and 1 remains on an extended course of vancomycin. Our study was limited by missing data; 30% of our patients were lost to follow-up. Although high rates of inadequate bowel prep were observed, further studies are needed to explore the significance of poor prep on FMT outcomes. Overall, the response rate supports the use of FMT for recurrent CDI in community hospitals.