P0123 - Bile Acid Profile Changes in Patients Who Develop Recurrent Clostridioides difficile Infection: A Pilot Study

Janice Cho, MD, William Harmsen, , Michael Camilleri, MD, Darrell Pardi, MD, MS, Sahil Khanna, MBBS, MS
Mayo Clinic, Rochester, MN

Introduction: Recurrent C. difficile infection (rCDI) is seen in ~20% after initial CDI despite absence of additional risk factors. Differences in bile acid composition may be implicated. Fecal bile acid (BA) excretion in a random stool sample is highly concordant to a 48-hour collection (correlation coefficient 0.947). Coefficients are more moderate for the secondary BAs, lithocholic acid (LCA) and deoxycholic acid (DCA), and higher for the primary BAs, chenodeoxycholic acid (CDCA), cholic acid (CA) in patients with intact colons, suggesting random stool samples may be used to study bile acid malabsorption. We measured primary to secondary bile acid ratios in spot stool samples at diagnosis and post-treatment and correlated changes with risk of rCDI.

Methods: Adult patients without chronic diarrhea and an index CDI episode were enrolled prospectively. We recorded demographics, CDI treatment and followed patients for 8 weeks to evaluate recurrence. We performed bile acid analysis on the CDI positive sample and an end-of-treatment sample. Fecal BA analysis was performed by high performance liquid chromatography and tandem mass spectrometry. Primary bile acids include CDCA and CA and secondary bile acids include LCA, DCA, and ursodeoxycholic acid (UDCA).

Results: Thirty-three patients (63.6% female, 90.9% Caucasian, median age 64 years [range 19-86yrs]) were enrolled. At CDI diagnosis, 12 patients (36.4%) were hospitalized and the rest were community-onset. Most patients were treated with vancomycin (n=31, 93.9%). Ten patients (30.3%) developed rCDI. Patients with a higher secondary to primary bile acid ratio at CDI diagnosis and then a higher primary to secondary bile acid ratio at the end of treatment (53.3%, 8 out of 15 patients)( i.e. a reversal in their bile acid ratio) had an odds ratio of 4.57 (95%CI 0.41 to 51.14, p=0.2173) of developing rCDI . Patients with rCDI had a higher primary to secondary BA ratio at end-of-treatment compared to those who had no recurrence (70.3 versus 6, p=0.0969) Table 1.

Discussion: Patients who had rCDI had a higher primary to secondary BA ratio at the end-of-treatment compared to patients who did not have CDI recurrence. Larger studies are needed to further explore this observation.

Bile acid	No recurrence (N = 21)	Recurrence (N = 10)	P-value
Total primary BA at diagnosis	1.1 (0.2, 3.9)	1.6 (0.2, 8)	0.6717
CDCA at diagnosis	0.2 (0.1, 3.8)	0.7 (0.1, 5.5)	0.5503
CA at diagnosis	0.5 (0.1, 3.8)	0.6 (0.1, 2.5)	0.8484
Total secondary BA at diagnosis	2.3 (0.7, 12.5)	14.6 (1, 29.3)	0.1830
LCA at diagnosis	0.5 (0.2, 4.5)	3 (0.2, 10.9)	0.1966
DCA at diagnosis	0.5 (0.3, 5.5)	6.2 (0.4, 15.1 )	0.3189
UDCA at diagnosis	0.2 (0, 0.7)	0.4 (0.1, 0.9)	0.2854
Primary to secondary BA ratio at diagnosis	0.5 (0.1, 1.7)	0.5 (0, 8)	0.7194
	No recurrence (N = 21)	Recurrence (N = 10)
Total primary BA at end-of-treatment	14.8 (9, 27.1)	14.9 (6.3, 34.9)	0.9370
CDCA at end-of-treatment	4 (1.4, 5.9)	3 (1.2, 7.9)	0.8536
CA at end-of-treatment	10.1 (6.1, 21.4)	12.3 (4.2, 22)	0.9370
Total secondary BA at end-of-treatment	2.1 (0.5, 5.9)	0.8 (0.1, 2.2)	0.1076
LCA at end-of-treatment	0.2 (0, 0.4)	0.1 (0, 0.4)	0.442
DCA at end-of-treatment	0.3 (0.2, 0.7)	0.2 (0, 0.3)	0.1809
UDCA at end-of-treatment	0.7 (0.1, 4.9)	0.3 (0, 0.6)	0.2987
Primary to secondary BA ratio at end-of-treatment	6 (1.8, 37)	70.3 (3.1, 173.3)	0.0969

Table: Bile acid composition at CDI diagnosis and end-of-treatment (data in mcmol/L, median, IQR)


Disclosures:
Janice Cho indicated no relevant financial relationships.
William Harmsen indicated no relevant financial relationships.
Michael Camilleri indicated no relevant financial relationships.
Darrell Pardi indicated no relevant financial relationships.
Sahil Khanna indicated no relevant financial relationships.


Janice Cho, MD, William Harmsen, , Michael Camilleri, MD, Darrell Pardi, MD, MS, Sahil Khanna, MBBS, MS. P0123 - Bile Acid Profile Changes in Patients Who Develop Recurrent Clostridioides difficile Infection: A Pilot Study, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.