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P217 Clostridium Difficile Infection as a cause of severe outcomes in patients with Inflammatory Bowel Disease

Fadeeva, N.(1);Knyazev, O.(1);Parfenov, A.(1);Kagramanova, A.(1);Lishinskaya, A.(1);Babayan, A.(1);Danilov, M.(1);Dolgopyatov, I.(1);

(1)A.S. Loginov Moscow Clinical Scientific Center, Department for IBD, Moscow, Russian Federation

Background

The prevalence of Clostridium difficile infection (CDI) in patients with inflammatory bowel disease (IBD) is higher than in general population. CDI may produce a negative effect on the clinical course of IBD. The aim of the study was to define the frequency of CDI in patients with IBD and to study risk factors that predict severe outcomes associated with CDI in IBD patients.

Methods

1278 medical records were analyzed in a retrospective study of patients with IBD, of which 808 patients met the inclusion criteria. Patients were divided into 2 groups based on the presence of a preliminary diagnosis of CDI.  Our primary outcome was time to total colectomy or death with follow-up censored at 180 days after CDI. Statistical analysis was carried out using Pearson Chi-square and two-sample t-test. 

Results

The frequency of CDI in patients with IBD was 17.6%. The mean age of occurrence of CDI in patients with IBD was 37.8±12.9. The first group included 143 patients CDI+IBD, and the second group - 665 patients IBD without CDI. In the first group C-reactive protein, erythrocyte sedimentation rate and fecal calprotectin levels were significantly higher and albumin level was lower than in the second group (р<0.05). The average albumin level in the first group was 20.8±1.83 mg/l, in the second group – 38.7±2.36 mg/l (р<0.05). Only 25.3% of all patients with CDI had a history of antibiotic use, and 30.4% had previously used steroids. Long-term immunosuppressive therapy in patients with IBD has an impact on the development of CDI: among patients with CDI 48.7% long-term received azathioprine/6-mercaptopurine, in patients without IBD – 18.3% (p<0.001). Only 19% of patients with CDI had control of the disease with salicylate therapy, while 62% of patients without CDI achieved remission by taking salicylates (p<0.05). Of these, 7 patients (4.9%) met our primary outcome (1 death, 6 colectomy) at a median of 21 days. On multivariate analysis, serum albumin<22 mg/L (HR 7.93, 95% CI 1.006-62.57), was independent predictors of our primary outcome.

Conclusion

The frequency of CDI in patients with IBD was 17.6%. The study shows that patients with IBD are more sensitive to the development of CDI at a young age, while not having such traditional risk factors as recent hospitalization or antibiotic use. Patients with IBD with CDI in history often noted the ineffectiveness of therapy with salicylates; often require the assignment of biological therapy. IBD patients with CDI have a lower average albumin, and a higher activity of the inflammatory process (p<0.05). Serum albumin<22 mg/L was independent predictors of severe outcomes in hospitalized IBD patients with CDI.

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