P1166 - The Impact of Steroids on the Incidence and Course of Clostridioides difficile Colitis in COVID-19 Patients Receiving Antibiotics

Param Patel, MD¹, Gurasees S. Chawla, MD², Chitra Punjabi, MD³, Arcelia Guerson-Gil, MD⁴, Lawrence J. Brandt, MD, MACG^2
1Montefiore Medical Center, New York, NY; ²Montefiore Medical Center, Bronx, NY; ³Albert Einstein College of Medicine, Bronx, NY; ⁴Jacobi Medical Center, Albert Einstein College of Medicine, New York, NY

Introduction: Clostridioides difficile infection (CDI) causes an estimated 2.5-fold increase in 30-day mortality among hospitalized pts. On a molecular level, colonization of the colon is followed by an inflammatory cascade similar to that of IBD. Given the utility of steroids in IBD, the relationship between CDI and steroids warrants further study. Existing literature is contradictory and limited by small sample sizes or varying indications for steroid treatment. By analyzing a large cohort of pts with a singular indication for steroid treatment (COVID-19), this study aims to determine the impact of steroids on the incidence and course of CDI.

Methods: A retrospective chart review of pts > 18 yrs old admitted with COVID-19 pneumonia to Montefiore Medical Center between March 1^st and September 30^th 2020 was completed. Pts with less than 3 doses of antibiotics in the 1^st week of admission were excluded. Remaining pts were divided into 2 groups: those treated with antibiotics and steroids and those who only received antibiotics. Demographics, 30-day CDI incidence, 60-day CDI recurrence, and 30-day CDI mortality were determined for each group. Relevant secondary analysis was conducted based on the results. Analyses were done using t-test, Chi-squared test, or Fisher’s exact test.

Results: 2,679 pts were part of our analysis (Figure 1). Only 29 pts were identified as CDI positive within 30 days of admission with no meaningful demographic differences between the groups. 60-day CDI recurrence did not differ between the groups either. Higher 30-day CDI mortality (33.3%, p = 0.1686) in the antibiotic and steroid group was noted with a trend towards significance. Rates of steroid treatment and those of known contributors to mortality were then compared between pts with and without CDI mortality (Table 1). Rate of steroid treatment in the CDI mortality group was higher (83.3%, p = 0.1686) than in the CDI without mortality group (43.5%, p = 0.1686). However, lower albumin levels (2.15, p = 0.007) and higher intubation rates (83.3%, p = 0.0025) were significantly associated with CDI mortality.

Discussion: Our results show statistically insignificant yet notably higher rates of 30-day CDI mortality in COVID-19 pts treated with antibiotics and steroids compared to those who received antibiotics only. A multi-center retrospective study of an even larger COVID-19 cohort is needed to increase the sample size of CDI positive pts and reveal any associations between steroid use, disease severity and mortality.




Disclosures:


Param Patel, MD¹, Gurasees S. Chawla, MD², Chitra Punjabi, MD³, Arcelia Guerson-Gil, MD⁴, Lawrence J. Brandt, MD, MACG². P1166 - The Impact of Steroids on the Incidence and Course of Clostridioides difficile Colitis in COVID-19 Patients Receiving Antibiotics, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.