P1167 - Characterization of Factors and Outcomes Associated With Recurrent Clostridium difficile Infection in Patients After Fecal Microbiota Transplant

Nikitha Vobugari, MBBS¹, Obada Tabbaa, MD², Sandeep Nadella, MBBS³, Michael P. Ramirez, MD², Nathan Kilian, MD⁴, Mark C. Mattar, MD^2
1Medstar Washington Hospital Center, Washington, DC; ²MedStar Georgetown University Hospital, Washington, DC; ³Northwell Health, Manhasset, NY; ⁴Georgetown University School of Medicine, Washington, DC

Introduction: Fecal microbiota transplantation (FMT) for Clostridium difficile colitis has cure rates of 70-90% with single/multiple transplants. Factors contributing to repeat FMT/treatment failure are unclear.

Methods: Upon retrospective chart review, 146 patients received FMT (2012 - 2020) within the Medstar Health system. Variables manually extracted include: 1. Demographics including age, sex, race, body mass index 2. Number of CDI prior to first FMT 3. Use of recent antibiotics defined as one month prior or after FMT and type of antibiotic 4. Use of PPI(40 vs 80 mg doses) 1 month prior or after FMT 5. Trial of CDI antibiotics prior to first FMT 6. Mode of administration 7. History of Inflammatory Bowel disease active flare vs inactive disease 8. Charlson Comorbidity Index (CCI) Score. Outcome variables: 1. Duration of symptoms in episode prior to first FMT vs duration of symptoms in episode after first FMT 2. Outcomes of improvement, refractory, recurrent vs. death. Statistical analysis with Chi-square test and Fisher test was performed (SAS software version 9.4)

Results: 53/145(36.5%) had recurrent CDI(rCDI) after 1st FMT, subsequently 28 patients (53%) received repeat CDI antibiotics vs. 8 patients (15%) received second FMT and 17 patients (32%) received both 2nd FMT and CDI antibiotics. 81% FMT were performed outpatient and 17% as inpatient. Incidence of rCDI among inpatient group - 17/25 (68%) vs. outpatient 34/118 (28%) P= 0.0163. Inpatient FMT patients had higher CCI scores and associated with a lower chance of success after the first FMT compared to outpatient FMT(p 0.0001). The use of non-CDI antibiotics like tetracyclines and fluoroquinolones a month prior or after FMT was associated with reduced likelihood of improvement after first FMT (p= 0.0141). FMT was frequently performed in females(61%) compared to males(38%); and it was likely to improve symptoms in females > males(p= 0.0114). The odds of improvement of symptoms with colonoscopy were 2.39 times more than other modes of administration(p= 0.0109). 70% of symptom improvement occurred after 1st FMT which increased to 82% with 2nd FMT vs 88% with only CDI antibiotics after 1st FMT

Discussion: First FMT success rate of 70% is similar to previously reported data. This improved to 82% with second FMT, supporting efficacy of repeat FMT in appropriate patients. Factors such as inpatient, prior use of tetracyclines/ fluoroquinolones and male gender may be associated with FMT failure. These need to be confirmed in a prospective study.


Figure: Figure A: Recurrent CDI occurred in 37% of patients after 1st FMT. Among them, 28 patients (53%) received repeat CDI antibiotics vs. 8 patients (15%) received second FMT and 17 patients (32%) received both 2nd FMT and CDI antibiotics.
Figure B: 70% of symptom improvement occurred after 1st FMT of total improvement, which increased to 82% with 2nd FMT vs. 88% with only CDI antibiotics showing efficacy of repeat FMT. Needs evaluation in prospective clinical trials.

Population:	n=145
Median (Range) Age in years	63 (4-98)
Age range in years
< 50	50
50-59	11
60-69	36
70-79	25
>80	23
Sex
Males	57 (39%)
Females	88 (61%)
Race
Caucasian or White	101 (70%)
Black or African American	22 (15%)
Other	22 (15%)
Location of treatment
Inpatient	25 (17%)
Outpatient	118 (81%)

Table: Table 1: Patient Characteristics


Disclosures:
Nikitha Vobugari indicated no relevant financial relationships.
Obada Tabbaa indicated no relevant financial relationships.
Sandeep Nadella indicated no relevant financial relationships.
Michael Ramirez indicated no relevant financial relationships.
Nathan Kilian indicated no relevant financial relationships.
Mark Mattar indicated no relevant financial relationships.


Nikitha Vobugari, MBBS¹, Obada Tabbaa, MD², Sandeep Nadella, MBBS³, Michael P. Ramirez, MD², Nathan Kilian, MD⁴, Mark C. Mattar, MD². P1167 - Characterization of Factors and Outcomes Associated With Recurrent Clostridium difficile Infection in Patients After Fecal Microbiota Transplant, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.