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RECURRENT REFRACTORY INPATIENT CLOSTRIDIODES DIFFICILE INFECTION AND FECAL MICROBIOTA TRANSFER THERAPY
M Shockley, LA Kondylis, P Kondylis
University of Central Florida/HCA GME Consortium: Greater Orlando

Background
Fecal Microbiota Transfer (FMT) has been primarily evaluated through small case reviews and meta analysis> Prior work has emphasized utility in the elective administration of FMT in clinically stable patients. This projects aims to evaluate factors associated with FMT outcomes in a larger cohort admission requiring patients.

Methods
A retrospective review of the prospectively acquired HCA enterprise patient care database was undertaken. Patients undergoing inpatient management of recurrent refractory Clostridiodes difficile infection from January 2015 through December 2019 were identified. Those less than 18 years of age were excluded. Those admitted with immediate surgical indications were excluded. Commercially available fecal microbiota was employed. Length of stay, length of stay before FMT, readmission rate, surgical intervention rate and mortality rate were reviewed. Logistic regression was employed to evaluate the database.

Results
10,632 patients underwent 11165 admissions. Mean age was 59.1 years. 58.6% were female. 77% of patients identified as white. Colon surgery was required in 0.8% of patients. Mortality rate per admission was 0.7% The 30 and 90 day readmission rates were 10.7% and 17.6% respectively. 609 patients (5.7%) underwent FMT. Nine (1.5%) of these patients went on to require surgical intervention. Six of these patients died.
At the 95% confidence interval, male patients are between 1.46 and 3.44 more likely to have colon surgery. Regardless of gender, for each year increase in age the odds ratio is 1.024 favoring colon surgery. Readmission was more common in the FMT group at both the 30 and 90 day endpoints.

Conclusion
A minority of patients being admitted for recurrent and refractory C difficile infection undergo FMT. Nine patients that failed FMT went on to colon surgery with six mortalities, potentially making non-response to FMT a grim prognostic factor, in the inpatient setting. Neither FMT nor the timing of FMT delivery during the hospital course were associated with impact on surgical requirement, or mortality, FMT was associated with readmission at both the 30 and 90 day intervals. FMT applicability in the inpatient setting merits further study.


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