LAUSR

Introduction Clostridium difficile infection (CDI) is the most common healthcare associated infection in the NHS with 12,275 cases reported in England in 2018/19. Recurrent Clostridium Difficile infection (rCDI) is an increasingly common problem; the recurrence rate is approximately 20% after a first episode and 45–60% after a second episode of C difficile infection, with mortality approaching 25% in elderly patients. Thus, rCDI is associated with significant healthcare costs and hospital admissions.1 Faecal microbiota transplant (FMT) is a NICE approved treatment for rCDI when treatments such as antibiotics have failed. FMT cure rates are consistently reported in the range of 80–90%.2 The aim of this audit was to assess the 6 week success rate of FMT procedures performed at Whiston Hospital for rCDI, and to evaluate the impact of FMT on preventing further hospital admissions. Methods Data was collected retrospectively on all patients undergoing FMT for rCDI between April 2015 to November 2019. Data was collected from electronic case notes and the local FMT database. Success rates were defined as resolution of diarrhoea 6 weeks post FMT. The number of CDI related admissions and days in hospital prior to and post FMT were also analysed. Results Twenty eight FMTs were performed on 20 patients (13 Females: 7 Males). FMT was performed via NG tube (19) gastroscopy (2), colonoscopy (2), NJ tube (4) and via enema (1). 6 patients (30%) required a second FMT and 1 patient required a third FMT. The 6 week success rate after the first FMT procedure was 12/20 (60%), second FMT 19/20 (95%) and third FMT 20/20 (100%). Within the 12 months prior to FMT the 20 patients had a median of 2 CDI related hospital admissions (range 0–13) and a median total length of stay of 29.5 days (range 0–104 days). 12-month post FMT data showed a reduction in the median number of hospital admissions (median 1, range 1–7) and in total length of stay (median 17 days, range 0–33 days). Conclusions Our data shows that FMT is a highly effective treatment for rCDI. All patients were diarrhoea free at 6 weeks, although our 1st FMT success rates are lower than previously reported in RCTs. FMT resulted in a reduction in the subsequent number of hospital readmissions and length of stay, thus reducing the financial burden on the NHS. References Public Health England. Annual epidemiological commentary: Gram-negative bacteraemia, MRSA bacteraemia, MSSA bacteraemia and C. difficile infections. 2019. http://www.gov.uk/phe (accessed 15 Feb 2020) Mullish BH, Quraishi MN, Segal JP, et al. GutEpub. The use of faecal microbiota transplant as treatment for recurrent or refractory Clostridium difficile infection and other potential indications: joint British Society of Gastroenterology and Healthcare Infection Society guidelines. (Accessed 16 Feb 2020). doi:10.1136/gutjnl-2018-316818