Presentation Authors: Rohma Ghani, Christine Gan, Benjamin Mullish, Vaishali Ferizoli*, Julian Marchesi, Mark Thursz, Frances Davies, Ranan Dasgupta, Suks Minhas, London, United Kingdom
Introduction: Patients with an underlying urological diagnosis colonised with multidrug-resistant organisms (MDRO) such as ESBL are predisposed to recurrent UTIs. Treatment can be prolonged with higher mortality and cost compared to infection with sensitive organisms. In FMT, healthy donor stool is administered into the GI tract to restore the healthy gut microbiota. This is acknowledged as an effective treatment for recurrent Clostridium difficile infection, and now as an emerging method of eradicating MDROs. However, there are little data reporting on its therapeutic value in Urology.
Methods: Retrospective analysis of culture positive urine isolates was obtained from 2015 to 2018 at a tertiary level service. Clinical profiling of patients under the urology service with recurrent ESBL producing isolates was performed. Four patients who had ESBL UTIs underwent FMT.
Results: Between June 2015-January 2018, 2059 patients under Urology services had a positive urine culture. 128 (6%) were positive for ESBL. 456 patients had more than one positive urine culture and of these, 62 (14%) had more than one ESBL UTI. This constituted 8% of all recurrent ESBL UTIs in the trust (806 total).52/62 (84%) with recurrent ESBL UTIs had an underlying urological diagnosis, while 10/62 (16%) were purely managed for recurrent UTIs. 19/62 patients had more than one underlying diagnosis. 7/62 (11%) patients underwent urological intervention, and 40/62 (65%) had longterm prosthetic devices in situ (Table 1).Four patients received FMT via NG tube, Table 2 describes their outcome.
Conclusions: ESBL UTIs are highly prevalent in Urology and underlying causes should always be investigated, due to the high incidence of obstructive aetiologies. Our early experience of FMT for both decolonisation and prevention of transition of colonisation to infection has shown FMT to be safe, well tolerated and effective therapy in urological management.