720 Does Undetectable Absolute Eosinophil Count at Initial Clostridioides difficile Infection Predict Future Disease in Inflammatory Bowel Disease Patients?

Abstract

INTRODUCTION: According to a 2018 study, an undetectable absolute eosinophil count at the time of admission for Clostridioides difficile infection (CDI) is associated with an increased risk for vasopressor requirement, emergency colectomy, and mortality during the index hospitalization. Patients with inflammatory bowel disease (IBD) are at greater risk for development of CDI than the general population. We aim to investigate whether an undetectable absolute eosinophil count at the time of an initial CDI can be used to predict recurrence versus reinfection of CDI in IBD patients. METHODS: A retrospective cohort of patients age 18-75 with a history of IBD and a diagnosis of CDI from January 2012–December 2016. The absolute eosinophil count at the time of initial CDI for patients with a history of single CDI and multiple CDIs was recorded. Absolute eosinophil counts were grouped as either detectable (>0.0 cells/mL) or undetectable (0.0 cells/mL). Recurrence was defined as CDI diagnosis within 3 months of the initial CDI. Reinfection was defined as a second episode of CDI between 3 months to 3 years of the initial CDI. Data was analyzed with chi square tests. RESULTS: 62 of 121 IBD subjects with CDI had a documented absolute eosinophil count at the time of their initial CDI. Absolute eosinophil count was undetectable in 15 of 62 patients (24.2%). Of these, 67% (n = 10) experienced multiple CDIs. 4 patients had recurrent CDI and 6 patients had CDI reinfections. 27 (43.5%) patients had history of a single CDI and 35 (56.5%) patients had a history of multiple CDI. An undetectable eosinophil count was observed in 18.5% (n = 5) of patients with a single CDI and 28.5% (n = 10) of patients with a history of multiple CDI. Of the 47 patients with a detectable eosinophil count, 22 patients experienced a single CDI vs 25 patients with multiple CDI. CONCLUSION: In patients with a peripheral eosinopenia, insufficient IL-25 mediated immunity can predispose patients to development of CDI. Although the absolute eosinophil count at the time of CDI may have implications for inpatient morbidity and mortality in the general population, our study suggests that an undetectable absolute eosinophil count at the time of initial CDI does not reliably predict future acquisition of CDI in IBD patients. However, based on the observation that patients with an initial undetectable eosinophil count more frequently experienced multiple CDIs, it is possible that a significant relationship could manifest with a larger study population.