Fecal microbiota transplant (FMT) is an effective treatment for recurrent C. difficile colitis.  FMT promotes increased gastrointestinal microbiota diversity, and in doing so may reduce the reservoir of uropathogenic bacteria, and even may promote re-colonization with microbial strains with favorable resistance profiles.  Despite these findings, the efficacy of FMT for UTI prevention is unknown.  We sought to investigate the association of fecal microbiota transplant (FMT) therapy, with UTI recurrence in individuals who had a history of recurrent UTI (rUTI) UTI.  We hypothesized that the cohort would have significantly fewer UTI episodes after FMT relative to prior to FMT.

A prospectively accrued database of patients who underwent FMT for recurrent Clostridoides difficile colitis was retrospectively reviewed for individuals with rUTI (2 UTIs in 6 months or 3 UTIs in one year) during the two years prior to FMT.  Recurrent UTI status and UTI frequency in the two years prior to the FMT were compared to those in the two year follow up period after FMT using the two-tailed Wilcoxin matched pairs signed rank test.  A p-value >0.05 was considered statistically significant.

Of 11 patients who had rUTI in the two years preceding FMT, no patient had rUTI over the follow up period following FMT (p=0.001).  The average number of UTIs in the two years prior to FMT was 3.7 (range 3-6), and the average number of UTIs in the follow up period was 0.27 (range 0-1) (p=0.001, Figure panel A).  The Kaplan-Meier estimate, the median time to UTI recurrence, was 19.6 mo (95% CI: 15.2 – 23.9, Kaplan-Meier curve in Figure panel B).  There was no marked difference in antibiotic susceptibility profiles before and after FMT.

FMT was associated with resolution of rUTI and reduction in UTI frequency in this cohort.  Uropathogen susceptibility to antibiotics was similar before and after FMT.

In the selected cohort, FMT was associated with reduced frequency of UTI in the two years after treatment.  The results of this study support the hypothesis that modulation of the gut microbiome may reduce rUTI risk, and support a future clinical trial to further assess the safety and efficacy of FMT for rUTI.