FMT for Refractory CDI Interrupts 25-Year History of Recurrent Urinary Tract Infections

An 83-year-old female had a 25-year history of recurrent urinary tract infections (UTIs) presented to our infectious disease clinic with 5 UTIs over 4 months. Symptoms diminished for only a week between antibiotic courses. Allergies to drugs limited treatment options, and antibiotics provided only temporary relief.

Two urinary cultures showed the presence of multidrug- resistant (MDR) Escherichia coli. Subsequent symptomatic episodes of cystitis yielded urine cultures showing increasing antimicrobial resistance. Symptoms prompted each urinalysis and urine culture, and all antibiotics were prescribed according to susceptibility results. Extensive non-antibiotic UTI prevention was attempted from 2010 to 2014.

In March 2015, she developed diarrhea and tested positive for C. difficile and was again treated with antibiotics. In the following 6 months, her symptomatic UTIs continued but with decreased symptom-free intervals. In May and October 2015, she had a C. difficile relapse and a fecal microbiota transplant (FMT) was planned. Stool from an unrelated donor underwent testing and was delivered via colonoscopy without complications. Nine days post-FMT, she had complete resolution of all UTI and Clostridium difficile infection (CDI) symptoms. At 25 months post-FMT, there had been no recurrences.

FMT is a safe and effective treatment for recurrent CDI and has also emerged as a potential therapy for decolonization of MDR organisms (MDROs). Here, we describe resolution of recurrent symptomatic UTI after FMT for recurrent Clostridium difficile infection in a woman who had been treated with nearly continuous antibiotics in the preceding two years. UTIs make significant contributions toward antibiotic resistance and antibiotic-associated infections. Our case adds evidence for FMT as a safe and potentially effective intervention for the treatment of infections outside of C. difficile, suggesting a possible role for FMT in combating antimicrobial resistance.

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