P0512 - The Diagnosis and Treatment of Clostridium difficile Diagnosed by Stool Polymerase Chain Reaction Does Not Alter the Clinical Course of Patients With Inflammatory Bowel Disease: A Case-Control Study
Hofstra North Shore-LIJ School of Medicine Manhasset, NY, United States
Ceena Chandrabos, MD1, Kana Chin, MD2, Yan Liu, PhD3, Nina Kohn, MBA, MA3, Arun Swaminath, MD4, Keith Sultan, MD5 1Hofstra North Shore-LIJ School of Medicine, Manhasset, NY; 2Long Island Jewish - Forest Hills, Queens, NY; 3Feinstein Institute for Medical Research, Manhasset, NY; 4Northwell Health, Lenox Hill Hospital, New York, NY; 5Northwell Health, North Shore University Hospital and Long Island Jewish Medical Center, Long Island, NY
Introduction: Inflammatory bowel disease (IBD) patients are highly susceptible to Clostridium difficile (C.diff) infections (CDI). Experts recommend using stool toxin assays for CDI diagnosis in IBD patients over the more sensitive and widely used polymerase chain reaction (PCR) assay, which is unable to distinguish colonization versus infection. CDI testing by toxin assay followed by antibiotics if positive has shown a decreased risk of future escalation of IBD therapy. We investigated whether a test and treat approach directed by positive stool PCR had similar outcomes.
Methods: All outpatients 18 years and older within our health system over the last 14 years with IBD and outpatient C.diff PCR testing with at least 1 year follow-up were analyzed. C.diff PCR positive patients were matched 1:1 to PCR negative patients by age, IBD type, extent, duration, and IBD therapy. Our primary outcomes compared escalation of IBD treatment and time to escalation within 1 year following C.diff testing. Escalations were defined as an addition/change of medications, increase in dose/ frequency of current therapy, or surgery.
Results: Of 168 IBD patients who were C.diff positive, 46 patients met inclusion criteria of which 60.9% had UC (ulcerative colitis), and had a median age of 35.5 years (range 20-92), and an average IBD duration of 7.9 years. 45 were treated for CDI (70% with vancomycin). Out of 2321 IBD patients who were C.diff PCR negative, 46 matches were identified, of which 60.9% with UC, a median age of 37.5 years (range 18-85) and mean IBD duration of 7.5 years. At 1-year follow-up, IBD treatment in the PCR positive group was escalated in 65% of patients, compared to 57% in the PCR negative group (p< 0.3458). Majority of the escalations were addition/change of biologic therapy (40% in PCR positive vs 38% in PCR negative group). Of those patients with an escalation in therapy, there was no significant difference of time to escalation within 1 year between groups (p< 0.7319) [Figure 1].
Discussion: Our results show that diagnosis and treatment of C.diff by PCR did not impact the clinical course in a cohort of IBD patients in the outpatient setting. The similar rates of escalation of IBD therapy between the C.diff PCR positive and PCR negative IBD patients lends real-world data to support that C.diff PCR positivity in the setting of IBD likely represents colonization rather than infection. Given these findings, C.diff PCR testing in this population should be avoided, as current guidelines recommend.
Figure: Title: Comparison of IBD Therapy Escalation between C. diff PCR Positive and C.diff PCR Negative IBD Patients x- axis label: Days to escalation y-axis: Probability of Treatment Not Escalated Blue Solid Line: C.diff PCR Negative IBD patients Red Solid Line: C.diff PCR Positive IBD patients
Ceena Chandrabos indicated no relevant financial relationships.
Kana Chin indicated no relevant financial relationships.
Yan Liu indicated no relevant financial relationships.
Nina Kohn indicated no relevant financial relationships.
Arun Swaminath indicated no relevant financial relationships.
Keith Sultan indicated no relevant financial relationships.
Ceena Chandrabos, MD1, Kana Chin, MD2, Yan Liu, PhD3, Nina Kohn, MBA, MA3, Arun Swaminath, MD4, Keith Sultan, MD5. P0512 - The Diagnosis and Treatment of Clostridium difficile Diagnosed by Stool Polymerase Chain Reaction Does Not Alter the Clinical Course of Patients With Inflammatory Bowel Disease: A Case-Control Study, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.