P0348Clostridioides Difficile Infection in Inflammatory Bowel DIsease: associated factors and disease outcomes

Abstract Background Clostridioides difficile infection (CDI) is frequent in inflammatory bowel disease (IBD) and its incidence is higher than in the general population1. Besides, it can have a negative impact in IBD1-2. There is controversy regarding some CDI risk factors in IBD3-4. The aim of this study is to analyze them, both in hospitalized patients and in outpatients. Methods We conducted a retrospective study including patients with CDI and IBD during the years 2020-2024, using the hospital’s Microbiology Department CDI database. Multistep testing was used to diagnose CDI, including positive toxigenic CD polymerase chain reaction (PCR) and positive toxin enzyme immunoassays (EIAs). Patient characteristics were evaluated before, during and after CDI. Fisher’s test was used to compare hospitalized patients and outpatients. IBD clinical activity was measured with Mayo Subscore for ulcerative colitis (UC) and Harvey-Bradshaw Index for Crohn’s disease (CD). Results 43 patients in total were identified. Their baseline characteristics of patients are illustrated in Table 1. The associated factors to CDI in IBD patients are shown in Figure 1A. Clinical activity before CDI was moderate to severe in 67.4% of patients (29). Once the diagnosis of CDI was established, 91.4%(32) had endoscopic activity. 60.5%(26) were admitted to the hospital. 69.8%(30) required an escalation of treatment (Figure 1B). No significant differences were found between hospitalized and outpatient groups, regarding associated factors, endoscopic activity,… Except in terms of recurrence. Recurrences occurred in 6 patients (14%), 5 hospitalized versus 1 in the community-onset. Patients with recurrences had a mean age of 69 compared to 46.4 in those without recurrences. Conclusion An usual risk factor of ICD in the general population is the previous use of antibiotic therapy. It is also present in IBD, but in just over half of this study’s patients. IBD activity increase the risk of ICD, and ICD negatively affects disease outcomes in IBD, with the need to escalate its treatment, in addition to the treatment of ICD. References: 1. Khanna S, Shin A, Kelly CP. Management of Clostridium difficile Infection in Inflammatory Bowel Disease: Expert Review from the Clinical Practice Updates Committee of the AGA Institute. Clin Gastroenterol Hepatol. 2017; Feb;15(2):166-174. doi: 10.1016/j.cgh.2016.10.024. 2. Vaughn, B. P., Khoruts, A., 120(2):313-319. doi.org/10.14309/ajg.0000000000003076. 3. T Kucharzik, P Ellul, T Greuter, J F Rahier, B Verstockt, C Abreu, et al, on behalf of the European Crohn’s and Colitis Organisation ECCO, ECCO Guidelines on the Prevention, Diagnosis, and Management of Infections in Inflammatory Bowel Disease, J Crohns Colitis, Volume 15, Issue 6, June 2021, 879-913. doi.org/10.1093/ecco-jcc/jjab052. 4. Kelly CR, Fischer M, Allegretti JR, LaPlante K, Stewart DB, Limketkai BN, et al. ACG Clinical Guidelines: Prevention, Diagnosis, and Treatment of Clostridioides difficile Infections. Am J Gastroenterol. 2021 Jun 1;116(6):1124-1147. doi: 10.14309/ajg.0000000000001278. Conflict of interest: Dr. Higuera Alvarez, Rebeca Oliva: Consultancy and speakers fees: Abbvie, Janssen, Takeda, Falk, Chiesi, Shire, Tillotts. Educational activities: Abbvie, Janssen, Abbot, Tillotts. Congress: Abbvie, Janssen, Takeda, Pfizer, MSD, Abbot, Chiesi, Falk, Tillotts, FAES, Ferring, Lilly. Arreba, Paz: i have potential conflicts of interest related to collaborations with Janssen, Tillots, Abbvie, Takeda, and Falk, including consulting, and participation in educational activities Buendía Carcedo, Laura: Collaborations with Janssen, Tillots, Abbvie, and Falk, including in educational activities Ortiz De Zarate Sagastagoitia, Jone: I have received fees for speaking and consulting.for Janssen, Ferring, fresenius. I have been paid to attend conferences and congress Takeda, Janssen, Lilly, Tillots and Faes