Mo1849 Long-Term Follow-Up After Fecal Microbiota Transplantation for C. difficile Infection in Inflammatory Bowel Disease Patients

Abstract

Background: C. difficile infection (CDI) is associated with poor outcomes in inflammatory bowel disease (IBD) patients such as IBD flares, hospitalization, surgery and recurrent CDI. Fecal microbiota transplantation (FMT) is effective for recurrent CDI, but the data on longterm efficacy and outcomes for CDI in IBD are scarce. Aim: To study long-term outcomes after FMT in adults with recurrent CDI and IBD. Methods: Adults with IBD and recurrent CDI enrolled in the FMT program from 08/2012 10/2014 were included. Donors and recipients were screened using a standard protocol and CDI treatment was stopped 24 hours prior to FMT. Concurrent IBD treatment including immunosuppression was continued. Donor stool was processed with 250 ml of non-bacteriostatic saline, and infused into the cecum via colonoscopy. Outcomes after FMT including CDI recurrence and IBD flares, surgery, among others were assessed by patient symptoms, stool tests, clinical assessments. Results: Thirty-eight patients were identified (27% Crohn's, 73% ulcerative colitis; 53% female) with median age 35.5 years (range, 18-77), and median IBD duration 4 years (range, 0.15-41). They had a median of 3 CDI episodes (range, 2-15) and a median of 4 (range, 2-14) failed CDI therapy regimens, with 59% patients failing at least one prolonged vancomycin taper. Fifty-five percent of patients were on 5-ASA agents, 42.4% on biologics and 36% on immunomodulators. Of all patients, 37% had symptom exacerbation suggestive of an IBD flare with CDI at the time of FMT. After FMT, 2 patients experienced severe abdominal pain, which was self-limited; emergency room evaluation and CT scan was unremarkable except for IBD activity. One patient developed transient hypotension, with concern for sepsis, required ICU admission and IV antibiotics, but symptoms resolved after intravenous fluid resuscitation. There were no long-term adverse events related to FMT. Post-FMT, 38% noted an improvement in their overall symptoms, 34% had no change in diarrheal symptoms, and 27% continued to have an ongoing flare. One-fourth needed escalation of their IBD therapy after FMT after successful resolution of CDI. Three patients had recurrent CDI after FMT and were managed with oral vancomycin, fidaxomicin and repeat FMT, respectively. No patient was able to decrease or discontinue IBD therapy after FMT. Conclusions: FMT appears to be a safe and effective mode of treatment of recurrent CDI in patients with IBD, and leads to resolution of CDI in most patients. However, FMT does not appear to improve the course of IBD in most patients.