1694. Successful Gut Decolonization of Extended-Spectrum β-lactamase Producing Klebsiella pneumoniae Using Oral Lyophilized Fecal Microbiota Transplant (FMT) in a Woman with Recurrent Urinary Tract Infections
Authors: Bier Naomi , Hanson Blake , Jiang Zhi-Dong , DuPont Herbert , Arias Cesar A , Miller William R 
Published: January 2021

Abstract

Background
In patients with anatomic disruption or long-term indwelling catheters of the urinary tract, recurrent infections can be a problematic complication. Exposure to multiple antibiotics can set the stage for the acquisition of resistant organisms. Restoration of a healthy gut microbiota may help such patients develop colonization resistance and eliminate multi-drug resistant organisms. We report the successful use of an oral FMT to decolonize an ESBL-producing K. pneumoniae (Kpn) from a woman with an ileal conduit with urostomy and recurrent urinary tract infections (UTI).

Methods
FMT was performed using PRIM-DJ2727, an oral encapsulated lyophilized stool product under investigation for treatment of Clostridioides difficile infection. Three doses of PRIM-DJ2727 (60 g total fecal matter lyophilized to 1g/dose) were given weekly under an Expanded Access Investigational New Drug Application protocol approved by the US Food and Drug Administration and the local Institutional Review Board. Urine and stool samples were collected prior to treatment, 1 week after the final FMT dose, at transplant day +70, and transplant day +180. Samples underwent nucleic acid extraction using the Qiagen DNeasy PowerSoli Kit and 16S rRNA sequencing on an Illumina MiSeq.

Results
A 50 year old woman with von Willebrand disease presented with recurrent UTIs after complications from a hysterectomy decades prior. She had an ileal conduit with urostomy, and for the prior 2 years had been colonized with an ESBL Kpn with recurrent episodes of pyelonephritis. In the preceding 6 months, she had 5 symptomatic UTIs (Fig 1). FMT was given 1 week after stopping antibiotics from the most recent UTI. In the 6 months subsequent to the FMT, she developed two symptomatic UTIs, with cultures positive for Achromobacter (Axyl), Stenotrophomonas (Steno), and Enterococcus spp. Axyl and Steno were not identified in the FMT product (Fig 2A). Stool α-diversity increased after the transplant, and recovered by 6 months despite oral fluoroquinolone therapy (Fig 2B). Interestingly, there was an inverse relationship between stool and urine α-diversity. ESBL Kpn was not recovered subsequent to the FMT.
Figure 1

Figure 2

Conclusion
Oral FMT was used to successfully decolonize a woman with recurrent UTIs due to ESBL Kpn.

Disclosures
Zhi-Dong Jiang, MD, DrPH, UT School of Public Health (Other Financial or Material Support, Patent for PRIM-DJ2727) Herbert DuPont, MD, UT School of Public Health (Other Financial or Material Support, Patent for PRIM-DJ2727) Cesar A. Arias, MD, MSc, PhD, FIDSA, Entasis Therapeutics (Scientific Research Study Investigator)MeMed (Scientific Research Study Investigator)Merck (Grant/Research Support) William R. Miller, MD, Entasis Therapeutics (Scientific Research Study Investigator)Merck (Grant/Research Support)Shionogi (Advisor or Review Panel member)