533. Scaling Pediatric Access to Fecal Microbiota Transplantation in the United States: A Time-Series Geospatial Analysis

Background The rising prevalence of recurrent Clostridium difficile infection (CDI) in pediatrics is a public health concern. Fecal microbiota transplantation (FMT) is an effective treatment and is recommended in US guidelines. Universal stool banks (USB) have enabled widespread FMT access among adult patients; however, the progression of FMT uptake in pediatrics is unknown. We present a geospatial timeseries analysis of growth in pediatric FMT providers within the United States between 2013 and 2018. Methods A list of healthcare facilities associated with a USB and an FMT special interest group was geocoded using Google Maps. Spatial network analysis methods were used to create drive-time polygons for each healthcare facility with simulated traffic for 12 pm on a Wednesday. US Census data were used to estimate the percentage population living within 1, 2, and 4-hour drive time to a pediatric FMT provider cumulatively from 2013 to March 2018. Results Between 2013 and 2018, there was a rapid expansion in access to FMT to include 45 pediatric healthcare facilities (Figure 1). As of March 2018, 40.51% of the US population lives within a 1-hour drive, 62.73% within a 2-hour drive, and 89.38% within a 4-hour drive of an FMT provider (Table 1). The largest percentage increases in access occurred between 2013 and 2014 (28.43% increase within a 1-hour drive time). These 45 FMT providers include 6 community hospitals, seven private practices, and 32 academic centers. Conclusion Although these results demonstrate a rise in pediatric FMT providers across the United States, there remains a significant discrepancy in access between adult and pediatric populations, despite growing evidence of safety and efficacy of FMT. Additional efforts are needed to address barriers to FMT and improve access for pediatric patients with recurrent CDI. Table 1: Pediatric FMT Facilities Within a 1, 2, and 4-Hour Drive Time Year No. of Partners Time (hours) % of US Population 2013 10 1 17.74 2 28.28 4 44.09 2014 15 1 22.79 2 36.88 4 60.74 2015 23 1 28.54 2 45.54 4 70.17 2016 33 1 34.14 2 55.23 4 79.57 2017 41 1 39.20 2 61.26 4 88.76 2018 45 1 40.51 2 62.73 4 89.38Figure 1. Pediatric Access to FMT From 2013 to 2018. Disclosures P. Panchal, OpenBiome: Employee, Salary.