C0085 - Incidence and Outcomes of C. difficile Infection Following Colon Ischemia

Award: Presidential Poster Award

Ahmad Nawaz, MD¹, Abdelkader Chaar, MD¹, Rabia Rizwan, MD¹, Karthik Gnanapandithan, MD², Muhammad Sohail Mansoor, MD³, Abdul Qadir Bhutta, MD⁴, Adil Bhutta, MD⁵, Marc Fenster, MD⁶, Olga Aroniadis, MD, MSc, FACG⁷, Savio John, MD⁸, Lawrence Brandt, MD, MACG⁹, Paul Feuerstadt, MD, FACG^10
1Yale University School of Medicine, New Haven, CT; ²Mayo Clinic Florida, Jacksonville, FL; ³GI Specialists of Georgia, Marietta, GA; ⁴SUNY Upstate Syracuse University Hospital, Syracuse, NY; ⁵Yale New Haven Health, Hamden, CT; ⁶Jacobi Medical Center, Bronx, NY; ⁷Stony Brook Medicine, Stony Brook, NY; ⁸State University of New York Upstate University Hospital, Syracuse, NY; ⁹Montefiore Medical Center, Bronx, NY; ¹⁰PACT Gastroenterology Center and Yale University School of Medicine, New Haven, CT

Introduction: Colon Ischemia (CI) is the most common ischemic injury to the gastrointestinal tract. Clostridioides difficile infection (CDI) is the most common healthcare-associated infection. There is limited knowledge of the risk of CDI after CI. Our hypothesis is that CI patients who develop CDI have worse outcomes compared with CI patients who don’t develop CDI.

Methods: We conducted a multicenter retrospective cohort study of patients admitted with biopsy-proven CI to Yale-New Haven Health Hospital, Montefiore Medical Center, Weiler Medical Center, and SUNY-Upstate Medical Center from 2005 to 2019. For each patient, we recorded numerous factors including the ACG severity scoring system. Patients who had CDI within 3 months following CI (CI+CDI) were compared to patients who did not develop CDI (CI-CDI). Primary outcome was to measure frequency of occurrence CDI in the CI population, secondary outcomes included comparing 30-day and 90-day colectomy, recurrent CI, readmission, and mortality from the time of diagnosis of CI, and segmental involvement of CI+CDI to CI-CDI. Multivariate logistic regression was performed after adjusting for the age, gender, race, Charlson Comorbidity Index (CCI) and the severity of CI.

Results: 906 patients met inclusion criteria with Bx proven CI. 3.2% developed CDI between 2005 and 2019 (Graph 1). There were no differences between CI+CDI (n=29) and CI-CDI groups (n=877) with regards to gender, BMI, medical co-morbidities, or severity. CI+CDI patients had more isolated right-colon involvement (38.8% vs 16.5%, p=0.013), 30-day readmission (51.7% vs 9.3%, p< 0.001), 90-day readmission (65.5% vs 18.1%, p< 0.001), 30-day reoccurrence of CI (17.2% vs 1.6%, p< 0.001), 90-day reoccurrence of CI (24.1% vs 3.6%, p< 0.001) and 90-day mortality (17.8% vs 7.5%, p=0.047) than CI-CDI. When adjusting for age, gender, race, CCI and severity, patients with CI+CDI were at higher risk for 30-day readmission [OR 10.62 (95% CI: 4.2-26.3), p< 0.001], 90-day readmission [OR 10.45 (95% CI: 4.0-26.8), p< 0.001], 30- day reoccurrence CI [OR 7.3 (95% CI: 1.9 -27.3), p=0.003] and 90-day reoccurrence CI [OR 5.7 (95% CI: 1.8-17.2), p=0.003] compared with CI-CDI group (table 1).

Discussion: CI patients who developed CDI had higher rates of CI recurrence, more frequent readmission, and were more likely to have isolated right colon involvement than CI-CDI. When a patient with a recent history of CI is diagnosed with CDI, they might benefit from more aggressive therapy to try to improve these outcomes.




Disclosures:


Ahmad Nawaz, MD¹, Abdelkader Chaar, MD¹, Rabia Rizwan, MD¹, Karthik Gnanapandithan, MD², Muhammad Sohail Mansoor, MD³, Abdul Qadir Bhutta, MD⁴, Adil Bhutta, MD⁵, Marc Fenster, MD⁶, Olga Aroniadis, MD, MSc, FACG⁷, Savio John, MD⁸, Lawrence Brandt, MD, MACG⁹, Paul Feuerstadt, MD, FACG¹⁰. C0085 - Incidence and Outcomes of C. difficile Infection Following Colon Ischemia, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.