B0098 - Risk Factors of Clostridium difficile Infection in Helicobacter pylori Diagnosed Patients: A Multicenter Study

Monday, October 24, 2022

10:00 AM – 12:00 PM ET

Location: Crown Ballroom

Has Audio

Presenting Author(s)

Samiksha Pandey, MBBS

William Beaumont Hospital
Royal Oak, MI

Samiksha Pandey, MBBS¹, Tamera Tennant, MD², Ashbina Pokhrel, MBBS², Andrew Aneese, MD², Alexandra Halalau, MD²
¹William Beaumont Hospital, Royal Oak, MI; ²Beaumont Health, Royal Oak, MI

Introduction: Clostridium difficile infection (CDI) is one of the most common gastrointestinal illnesses. However, there are conflicting studies regarding the association of CDI with Helicobacter Pylori (H pylori) treatment regimens. Our aim is to investigate the risk of CDI in those treated for H. pylori as well as characterize other risk factors for developing CDI.

Methods: A retrospective study was performed in the adult population diagnosed with H. pylori within the Beaumont Hospital system in Michigan, from 2010 to 2021. Inclusion criteria included age > 18 years and diagnosis of H. pylori with one of three proven methods: endoscopic biopsy with pathology, stool antigen test or urea breath test. Treatment was defined as being prescribed any one of the established multi-regimen therapies used to treat H. pylori. Diagnosis of CDI was queried in two groups: within 6 months and 12 months of H pylori diagnosis, while both required a positive stool toxin or PCR for diagnosis. Analysis was performed using SAS 9.4 (SAS Institute, Cary, NC).

Results: Among 11,457 patients, 56 (0.48%) had a subsequent CDI, with 5 (0.21%) and 35 (0.38%) among treated and untreated groups respectively. A total of 2341 (20.43%) patients were treated for H. pylori infection, and the most common regimen was clarithromycin based triple therapy in 1944 (17%). In a case control analysis for CDI within 6 months of H. pyloridiagnosis, matched for 10-year age interval, sex and 3-unit BMI intervals with those without CDI, 23 (41.1%) vs 17 (30.4%) had been prescribed an antibiotic known to be associated with CDI, 5 (8.9%) vs 4 (7.1%) had been prescribed a histamine receptor 2 (H2) blocker, and 30 (53.6%) vs 29 (51.8%) had been prescribed a proton pump inhibitor (PPI). The odds of previous hospitalization among those who developed CDI are 300% greater than those who did not develop CDI (p value 0.04).

Discussion: We found that there was no association of future CDI with treatment of H. pylori infection. This result was similar to the study done by Kumar et. al. in a large veteran population, which did consist of a higher percentage of male patients, and our study consists of more female patients. In addition, our study reaffirms the notion that previous hospitalization is a risk factor for developing CDI. There were a few limitations including the inability to confirm if patients received treatment from an external electronic medical record or if they completed the prescribed treatment regimens.

Figure: Figure 1. CDI in H. pylori diagnosed patients.

	Total CDI (56)	No CDI (1401)
Mean Age, in years	57.6	47.8
Sex
Female	38 (67.9%)	6823 (59.8%)
Male	18 (32.1%)	4578 (40.2%)
Race
Caucasian	28 (50%)	5934 (52%)
African American	16 (28.6%)	1788 (15.7%)
Others	10 (17.9%)	2786 (24.4%)
Treatment Regimen within 180 days
Clarithromycin based triple therapy	5 (8.9%)	1939 (17.0%)
Clarithromycin based concomitant therapy	3 (5.4%)	211 (1.9%)
Bismuth quadruple therapy	0	246 (2.2%)
Levofloxacin based triple therapy	0	130 (1.1%)
Levofloxacin based quadruple therapy	0	2
Rifabutin based therapy	0	13 (0.1%)

Table: Table 1. Comparison of characteristics of H. pylori diagnosed populations within 12 months of CDI and without CDI.

Disclosures:

Samiksha Pandey indicated no relevant financial relationships.

Tamera Tennant indicated no relevant financial relationships.

Ashbina Pokhrel indicated no relevant financial relationships.

Andrew Aneese indicated no relevant financial relationships.

Alexandra Halalau indicated no relevant financial relationships.

Samiksha Pandey, MBBS¹, Tamera Tennant, MD², Ashbina Pokhrel, MBBS², Andrew Aneese, MD², Alexandra Halalau, MD². B0098 - Risk Factors of Clostridium difficile Infection in Helicobacter pylori Diagnosed Patients: A Multicenter Study, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.