Transcript 11 January

Skinning the Cat Twice: Refractory CDI in a Solid Organ
Transplant Patient Requiring 2 Fecal Microbiota Transplants
Sarah Ordway, MD; Nieka Harris, MD; and Roy Wong, MD,MACG
Presentation
 Recurrent Clostridium difficile infection (RCDI)
remains a management challenge
 Fecal microbiota transplantation (FMT) is safe
and efficacious for these patients
 There is a paucity of literature describing FMT
efficacy and safety in solid organ transplant
(SOT) patients
Legend:
= Occurrence of CDI
= Hospital admission
= FMT
Cost Comparison
A 64 year-old immunocompromised male with
ESRD due to poorly controlled DMII and
hypertension, 8 years status-post living donor
kidney transplant, presented with abdominal
pain, 48 hours of 10 loose stools and a positive
C. difficile PCR following antibiotic exposure for
healthcare-associated pneumonia
Hospitalized with
severe sepsis
$200,000
$190,934
$180,000
$166,656
$160,000
$140,000
Healthcare Cost
Introduction
$120,000
$100,000
$80,000
CDI Severity
$60,000
$40,000
Severe
Pseudomembranous
colitis
Mild/Mod
$23,437
$20,000
$13,103
$9,920
$231
$0
Total Cost Hospital Cost
Baseline
11/12/13
11/26/13
12/9/13
1/6/14
3/21/14
3/30/14
4/10/14
Treatment before FMT
Antibiotics
$841 $2,952
Procedures
FMT treatment
Treatments required
FMT was significantly more cost effective
12 November
• 1 day oral
metronidazole
500mg TID
13 November
• 10 days Oral
Vancomycin (OV)
125mg Q6H
9 December
• 14 days OV
500mg Q6H
No recurrences within 6 months of 2nd FMT
30 March
• 1 day OV
250mg Q6H
Discussion
 Solid organ transplant recipients suffer a higher
frequency of CDI, tend to have more severe disease
 Our renal transplant patient achieved a lasting
response following sequential FMT without infectious
complications up to 6 months post FMT
 SOT recipients with RCDI who fail initial FMT may have
more severe dysbiosis and may benefit from sequential
FMT
The views expressed are those of the authors, and do not reflect the opinion of the Walter Reed National Military Medical Center, the United States Army, or the United States Government.