The Impact of Stool Banks on Access to Fecal Microbiota Transplantation for Recurrent Clostridium Difficile Infection in the United States: A Geospatial Analysis: 2016 ACG Presidential Poster Award: 948

Introduction: Recurrent Clostridium difficile infection (rCDI) is a growing and costly public health threat. Fecal microbiota transplantation (FMT) has emerged as an effective treatment, though logistical barriers prevented widespread adoption. The availibility of FMT material from universal stool banks has expanded access to FMT for both providers and patients. However, the extent of this impact has not been well documented. We present a geospatial analysis of FMT adoption using material obtained from the largest public stool bank in the US. Methods: Data on health facilities or providers that performed FMT using material from a stool bank was available as a master list aggregated by US ZIP Codes (OpenBiome). Using standard GIS methods, duplicate geo-coded ZIP codes were removed given redundancy in catchment zones for driving times, and geocoded drive-time polygons were generated using network analysis for each FMT provider (TIGER/Line 2014, ArcMap 10.4, ESRI Business Analyst 2015). US census data (Oak Ridge National Laboratory LandScan 2014) with a 1 km2 resolution was used to estimate the population contained within each drive-time polygon. Zonal statistics were used to estimate percentage of the US population within a 1-hour, 2-hour, and 4-hour drive time from an FMT provider using simulated traffic for a Wednesday at noon for all facilities. Results: We identified 655 facilities that provided FMT from a public stool bank with 585 unique ZIP codes. Among these FMT programs, 94 were academic medical centers, 432 community hospitals, 102 private practices/ambulatory surgical centers and 27 operated by either a federal, state, or local government agency. Most of these sites are located in the Southern (230) and Western (177) United States, with fewer located in the Midwest (117), Northeast (127) and Pacific (4) regions. Overall, 99.7% of the population live within a 4-hour drive, 96.7% of the population within a 2-hour drive and 83.2% of the population within a 1-hour drive of a FMT provider using material from a stool bank (Figure 1). Only 40% of facilities previously performed FMT prior to using fecal material from a stool bank.Figure 1Conclusion: In the US, the advent of stool banks has enabled nearly universal access to FMT for rCDI, notably at facilities that may not have otherwise been able to offer the therapy. Given the reduction of time and distance to FMT that this access affords patients, further research should explore how universal access to FMT has impacted the epidemiology of CDI.