Merwise Baray, BS1, Zachary Dickson, MD1, Thomas Hunold, BSPH2, Brian Behm, MD1, R. Ann Hays, MD1
1University of Virginia Health System, Charlottesville, VA; 2University of Virginia, Charlottesville, VA
Introduction: In inflammatory bowel disease patients (IBD), Crohn’s disease carries a greater risk for surgical resection than ulcerative colitis (UC) through 10 years after diagnosis. Prior studies identify small bowel resection and colectomy as risk factors for the development of Clostridioides difficile infection (CDI). This study assessed the correlation between acquisition of CDI and timing of intestinal resection in IBD patients.
Methods: A retrospective cohort of patients age 18-75 with a history of IBD and a diagnosis of CDI from Jan 2012 – Dec 31, 2016. Patient demographics, history of intestinal resection, and history of a single CDI or multiple CDI were reviewed. CDI index case was chosen as the infection with the closest timing to intestinal resection. Statistical analysis was performed with Chi-square testing.
Results: 121 IBD patients with CDI were identified. 48 patients (39.7%) underwent surgical resection (25 UC and 23 Crohn's). Of these, 16 patients had a single episode of CDI and 32 patients had a history of multiple CDI. CDI occurred prior to intestinal resection in 84% of UC patients and only 47.8% of Crohn’s patients (p=0.008). This relationship was mirrored in those with history of multiple CDIs (p=0.006), but not for patients with history of a single CDI (p=0.38). Within 1 month of surgical resection, there was no difference in the development of CDI for Crohn’s compared to UC patients. However, in Crohn’s patients with a history of multiple CDI, 77.8% experienced a CDI after a partial or total colectomy.
Discussion: In this cohort of IBD patients, CDI prior to surgery is more common in UC patients as compared to Crohn’s. This likely reflects CDI’s predilection for the colonic mucosa, which is altered by the pro-inflammatory state of UC. A history of CDI is not as common in Crohn's patients undergoing surgery likely due to decreased colonic involvement. Further investigation into CDI in Crohn’s patients after colonic resection is warranted. This information may be used to guide therapeutic discussions with IBD patients who are diagnosed with CDI.
Citation: Merwise Baray, BS; Zachary Dickson, MD; Thomas Hunold, BSPH; Brian Behm, MD; R. Ann Hays, MD. P0488 - INTESTINAL RESECTION AND CLOSTRIDIOIDES DIFFICILE INFECTION IN INFLAMMATORY BOWEL DISEASE PATIENTS: A SINGLE CENTER RETROSPECTIVE COHORT STUDY. Program No. P0488. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.