Abstract: SA-PO972

Successful Fecal Microbiota Transplant in an ESRD Patient

Session Information

Category: Nephrology Education

  • 1302 Fellows and Residents Case Reports

Authors

  • Kenny Thomas, Jeffy, Emory University School of Medicine, Atlanta, Georgia, United States
  • Cobb, Jason, Emory University School of Medicine, Atlanta, Georgia, United States
  • Suh, Jung W, Atlanta Gastroenterology Associates, Atalnta, Georgia, United States
Background

The incidence of clostridium difficile (c. difficile) colitis is increasing and there are reports of 10-25% of patients treated with medical therapy (metronidazole or vancomycin) having relapse of colitis despite medical therapy. A treatment option in these refractory or recurring c. difficile colitis cases is fecal microbiota transplant (FMT). There is a paucity of data of c. difficile colitis in patients with kidney disease. We present a case of an ESRD patient with refractory c. difficile colitis that underwent a successful FMT.

Results

60 year-old African-American female with ESRD requiring hemodialysis for 3 years. Her ESRD is due to diabetic nephropathy. She was admitted to an outside hospital in March 2017 for coronary artery disease and atrial fibrillation, and was transferred to our hospital for further cardiac care. She received intravenous antibiotics at the outside hospital for 1 day. Upon presentation to our hospital, she had severe diarrhea which required the placement of a fecal management system. Her stool was positive for c. difficile and due to the severity of her disease oral vancomycin was initiated. Despite treatment for 12 days with oral vancomycin, intravenous metronidazole was added. She continued to have persisting diarrhea despite treatment. She received bezlotoxumab (human monoclonal antibody for the treatment of c. difficile infections) but continued to have severe watery diarrhea. Gastroenterology was consulted and a decision was made to perform a FMT. The patient received a FMT on April 14th and April 25th, 2017. It was performed per colonoscope with 60 ml syringes of fecal material being injected in the terminal ilium and cecum for a total of 240 ml each time. At the time of discharge (14 days after initial FMT) the patient was off antibiotics, off probiotics, and having only one semi-formed stool each day.

Conclusion

This is the first case of an ESRD patient undergoing a FMT and shows that it is a safe treatment option in ESRD patients with refractory or relapsing c. difficile colitis.