Stool Bank Research Articles

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

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.

Sa1064 The International Public Stool Bank: A Scalable Model for Standardized Screening and Processing of Donor Stool for Fecal Microbiota Transplantation

the inpatient quality indicators of length of stay (LOS), 30-day re-admission rates, and mortality for patients admitted to our academic medical center for gastrointestinal bleeding. Methods: We retrospectively evaluated admissions for gastrointestinal bleeding based on ICD-9-CM codes from May 2011-June 2013 at the University of Miami Hospital (Miami, FL). The patients were primarily managed by one of four types of inpatient service as follows: GI teaching service, academic medicine teaching service, private hospitalist, or surgical service. Patients initially admitted to an intensive care unit from the emergency department were excluded. To account for potential differences in severity of GI bleeding between services, patients were matched by propensity score based on their age, location of bleed (upper GI bleed vs lower GI bleed), and whether the bleed was secondary to portal hypertension. Results: 600 hospital admissions for GI bleeding were included (GI 84, academic 44, private 436, surgical 36). No difference was noted in the mean LOS among groups (GI 4.72 days, academic 5.56 days, private 5.96 days, and surgeons 6 days, ANOVA F=1.44, p= 0.23). No difference was observed in the 30 day re-admission rate (GI 1.85%, academic 5.13%, private 4.51%, surgeons 3.03%, Pearson's chi-squared 1.03, p=0.79). No difference was seen in the in-hospital mortality rate (GI 1.89%, academic 2.56%, private 2.13%, surgeons 0%, Pearson's chi-squared 0.77, p=0.86). Following propensity score matching, 491 patients were evaluated. No differences were noted in LOS (ANOVA, F=2.95, p= 0.053) or re-admission rates (LR Chi-squared 1.64, p=0.44) among groups. Conclusion: No significant difference was observed in inpatient quality indicators for a GI specialty service at an academic center. However, small numbers may have prevented these values from reaching significance as trends were observed favoring the GI team with LOS and readmission, making a larger sample size and a cost evaluation important next steps in this evaluation process.

499 Donor Recruitment and Eligibility for Fecal Microbiota Transplantation: Results From an International Public Stool Bank

499 Donor Recruitment and Eligibility for Fecal Microbiota Transplantation: Results From an International Public Stool Bank

69 Autistic Disorders – Disability Quantification Scale (CREPS SCALE)

Fecal microbiota transplantation (FMT) is being studied and utilized for various medical conditions including Clostridium difficile colitis, inflammatory bowel diseases (IBD), obesity, myasthenia gravis, and so on. Yet, FMT donation, whether from an individual or a stool bank, can be challenging given the numerous requirements and donor costs. Furthermore, data outcomes on recipients of FMT regarding donor’s health co-morbidities, age, and weight are limited but emerging. The purpose of this review is to evaluate cost, safety, and accessibility in FMT donation.

CASE OF TUMOUR OF THE PONS ASSOCIATED WITH DEGENERATION IN THE POSTERIOR COLUMNS OF THE CORD

<h3>Background</h3> Inflammatory bowel disease (IBD) is a set of conditions characterized by non-infectious chronic inflammation of the gastrointestinal tract. These primarily include Crohn’s disease (CD), ulcerative colitis (UC) and indeterminate colitis. Fecal microbiota transplantation (FMT) has proven to be an effective treatment for some patients with active UC. There is currently no procedure allowing to predict the patients’ response and to select the most adequate donor(s). <h3>Aim</h3> Investigate microbiome characteristics in association with responder/non-responder status and develop selection criteria for donor samples to be used for UC FMT. <h3>Methods</h3> Available UC longitudinal FMT microbiome data sets were in part combined and reanalyzed, with focus on species level changes in the microbiota, using state-of-the-art 16S analysis routines. <h3>Results</h3> We predicted antibiotic resistance to be higher in non-responders (p=0.0064). Microbiomes of UC FMT responder donors have higher phylogenetic diversity (p=0.0026) and a higher proportion of facultative anaerobes (p=3.3E-5) as compared to non-responder donors. We predicted succinate and histamine to be increased in non-responder donors and non-responders, respectively. Sialic acid catabolism was also predicted to be increased in non-responder donors. Tryptamine and indole-3-acetaldehyde were predicted to be increased in responder donors. <h3>Conclusions</h3> Our findings contribute to the establishment of selection criteria for UC FMT donor samples and composition guidelines for future synthetic microbial communities. Our results suggest that oxidative stress resistant facultative anaerobes are important for the establishment of an anaerobic environment and a successful UC FMT therapy. Several metabolites can be tested for additional optimization or prioritization of stool bank samples for UC FMT. Our results question the usefulness of antibiotics based preparation of the gut, prior to FMT.