Abstract: SA-PO965

Peritonitis Following Fecal Microbiota Transplantation (*2) via Colonoscopy in a Peritoneal Dialysis Patient

Session Information

Category: Nephrology Education

  • 1302 Fellows and Residents Case Reports

Authors

  • Mulay, Shree Ramakant, University of Wisconsin, Madision, Madison, Wisconsin, United States
  • Waheed, Sana, University of Wisconsin, Madision, Madison, Wisconsin, United States
Background

Fecal microbiota transplantation (FMT) is commonly utilized in the treatment of recurrent Clostridium difficile (C. diff) infection. However, there is no consensus on how best to manage these patients who are on peritoneal dialysis (PD) regarding administration of prophylactic antibiotics prior to FMT. We share our experience with one such case requiring an FMT who subsequently developed peritonitis.

Methods

A 50-year-old female on peritoneal dialysis for end stage renal disease secondary to ANCA vasculitis and recurrent C. diff infection was admitted with abdominal pain and severe diarrhea. She was found to have another C. diff infection and since she had already failed treatment with oral vancomycin and fidaxomicin a decision was made to proceed with FMT via colonoscopy. Given the concern that she may not have a successful FMT if given prophylactic antibiotics, she was not given any antimicrobial prophylaxis and all antibiotics were held 48 hours prior to the procedure. She resumed peritoneal dialysis after the procedure and her fluid remained clear. However, 2 days later her diarrhea and abdominal pain recurred. She had an extensive GI work up and no alternative explanation could be found for her abdominal pain and her C. diff remained positive. She underwent another FMT considering the fact that there could be a 5-10% failure rate with the procedure. Again, she was not given prophylactic antibiotics. Her PD fluid turned cloudy the next day and she had low grade fever and her PD fluid cell count showed a total of 404 nucleated cells with 29% polymorphic neutrophils. Her PD culture grew Enterococcus faecalis and she was treated with intraperitoneal daptomycin daily for a total of 3 weeks. Her abdominal pain and diarrhea have not recurred since the second FMT.

Conclusion

FMT can be used to successfully treat patients on peritoneal dialysis with recurrent C. diff. However, our patient developed peritonitis as a result of the procedure which can be a risk if prophylactic antibiotics are not administered. We suspect she developed peritonitis from the second FMT because it was associated with a more thorough diagnostic (exploratory) colonoscopy. We recommend that the risk of peritonitis be discussed in detail with patients who are on peritoneal dialysis undergoing FMT.