Mo1216 Rescue Fecal Microbiota Transplantation in Refractory Severe and Complicated Clostridium difficile Infection Using Frozen Stool Specimens

Abstract

Objectives: Recent studies have shown increases in both the incidence and severity of Clostridium difficile infection (CDI), with 30 day mortality rates of 25% in the inpatient setting and 37% in the ICU. Fecal Microbiota Therapy (FMT) has been shown to have mean cure rates of approximately 91% in recurrent CDI. The role and outcome of FMT in the ill patient failing to improve with appropriate standard pharmacologic therapy is less well defined. Frozen stool enables urgent FMT treatment. The goal of this study is to present our experience with the use of frozen stool samples, obtained from a stool bank, in the treatment of critically ill patients with refractory CDI with the primary intent of identifying outcome at 30 days, including mortality. Methods: The electronic medical records of patients treated with FMT for refractory CDI were reviewed and disease severity was analyzed using the Modified Horn Index (MHI). All stool samples were obtained using a frozen stool bank with administration via colonoscope. Results: Over the course of ten consecutive months, following the ready availability to providers in our region, eight inpatients with severe and complicated refractory CDI were treated with FMT. Five of the eight had an MHI of three, and three of the eight had an MHI of four. Three of the eight patients were treated with planned sequential FMT (two FMT treatments each). One patient required colectomy despite FMT therapy. 30 day mortality was 25%, one of the deaths being unrelated to CDI. All six of the patients who were alive at 30 days were without recurrence of CDI. Conclusions: The addition of Fecal Microbiota Transplantation, using frozen stool specimens, appeared to be life-saving and/or prevented the need for colectomy in the majority of patients with severe and complicated CDI refractory to aggressive standard pharmacologic therapy.