P303 Gastrointestinal infectious agents detected by Biofire FilmArray GI PCR panel stool testing in active inflammatory bowel disease are common and associated with a more benign course of IBD
Limsrivilai J.1,2, Stidham R.W.3, Govani S.3, Waljee A.3, Gutermuth B.3, Brown A.3, Briggs E.3, Rao K.4, Higgins P.D.*5
1Mahidol University, Bangkok, Thailand 2University of Michigan, Internal Medicine - Gastroenterology, Ann Arbor, Michigan, United States 3University of Michigan, Internal Medicine - Gastroenterology, Ann Arbor, United States 4University of Michigan, Internal Medicine - Infectious Diseases, Ann Arbor, United States 5University of Michigan, Internal Medicine - Gastroenterology, Ann Arbor, MI, United States
Using standard techniques, only 10% of inflammatory bowel disease (IBD) patients with symptoms have detectable gastrointestinal (GI) tract infections. Detection is limited by the sensitivity of these tests.
We reviewed BioFire GI stool results for all adult IBD patients from April to October 2016 at our center. We excluded patients on antibiotics in the last 2 weeks, UC patients status post colectomy, and patients with symptoms from other causes, e.g. pancreatitis or infections outside GI tract. We compared the risk of GI infection between those with active and inactive IBD defined by inflammatory markers (using QuantumBlue fecal calprotectin), imaging findings, or endoscopic /biopsy findings. Among actively inflamed IBD patients, we compared clinical characteristics, medication use, and disease course (need for escalation of immunosuppressive agents and need for surgery) between those with positive and negative tests.
131 IBD patients (60 active CD, 14 inactive CD, 54 active UC, and 3 inactive UC) were included. Most (88.6%) were inpatients. Thirty-nine had positive results; common types of infection included Norovirus,
A surprisingly large fraction, one-third of IBD patients with symptoms and objective evidence of gut inflammation, had infectious agents detected in their stool. The course of IBD in patients with these infections was more benign than those with negative tests. It appears that more sensitive testing for acute infections can be prognostically helpful, particularly in IBD patients with acute worsening of symptoms, and the use of steroids and escalation of IBD therapy could be reduced if stool infections are identified early.