P13-2 Prevalence of recurrent Extended-Spectrum Beta-Lactamase (ESBL) urinary tract infections (UTIs) in patients within a Urology service and introducing the concept of Faecal Microbiota Transplantation (FMT) as a treatment modality

Dr Rohma Ghani1, Miss Christine Gan2, Dr Benjamin Mullish3, Dr Vaishali Ferizoli2, Dr Frances Davies1, Professor Mark Thursz3, Professor Julian Marchesi4, Mr Ranan Dasgupta2, Mr Suks Minhas2 1Department of Microbiology, Imperial College Healthcare NHS Trust, London, United Kingdom, 2Department of Urology, Imperial College Healthcare NHS Trust, London, United Kingdom, 3Department of Gastroenterology, Imperial College Healthcare NHS Trust, London, United Kingdom, 4Department of Digestive Diseases, Imperial College London, London, United Kingdom

Introduction: Patients with an underlying urological diagnosis colonised with multidrug-resistant organisms (MDRO) such as ESBL are predisposed to recurrent UTIs. In FMT, healthy donor stool is administered into the GI tract to restore healthy gut microbiota. This is acknowledged as an effective treatment for recurrent Clostridium difficile infection, and now as an emerging method of eradicating MDROs. There are little data reporting on its therapeutic value in Urology.

Methods: Retrospective analysis of culture positive urine isolates was obtained from 2015-2018 at a tertiary level service. Clinical profiles of patients with recurrent ESBL UTIs was performed. Four patients who had ESBL UTIs underwent FMT.

Results: From June 2015-January 2018, 2059 patients under Urology services had a positive urine culture. 128 (6%) were ESBL. 456 patients had multiple positive urine cultures. Of these, 62 (14%) had multiple ESBL UTIs, constituting 8% of recurrent ESBL UTIs in the trust (806 total). 52/62 (84%) with recurrent ESBL UTIs had underlying urological diagnoses; 10/62 (16%) were purely managed for recurrent UTIs. 19/62 patients had >1 underlying diagnosis. 7/62 (11%) had urological reconstruction. 40/62 (65%) had prosthetic devices in situ (Table 1). Four patients received FMT, Table 2 describes their outcomes.

Conclusions: ESBL UTIs are highly prevalent in Urology. Underlying causes should be investigated, due to high incidence of obstructive aetiologies. Our early experience of FMT for decolonisation and prevention of transition to infection with MDROs has shown FMT to be safe, well tolerated and effective.