721 Risk Factors for Recurrence vs. Reinfection of Clostridioides difficile Infection in Inflammatory Bowel Disease: Single Center Retrospective Study

Abstract

INTRODUCTION: Patients with inflammatory bowel disease (IBD) are at greater risk for development of Clostridioides difficile infection (CDI) than the general population, ulcerative colitis (UC) more so than Crohn's disease (CD). Although the data regarding risk factors for development of CDI in IBD patients is conflicting, a 2019 meta-analysis suggested recent antibiotics, colonic involvement in CD, and biologic therapy to be significant risk factors. This study investigated the role of these risk factors and the use of proton pump inhibitors (PPI), opiates, and steroids in the development of recurrence vs reinfection of CDI in IBD patients. METHODS: A retrospective cohort of patients age 18-75 with a history of IBD diagnosed with CDI from January 1, 2012–December 31, 2016. Recurrence defined as CDI diagnosis within 3 months of the index CDI. Reinfection defined as second episode of CDI between 3 months to 3 years of the index CDI. Patient demographics, antibiotics used to treat index CDI, presence of colonic involvement, and use of PPIs, opiates, biologics, and steroids at the time of second CDI were recorded. Data was analyzed with Fisher's exact test and student t-tests using SAS 9.4 software. RESULTS: A total of 121 IBD patients with CDI were identified: 60 with Crohn's and 61 with UC. 59.5% of IBD patients had either recurrent CDI or CDI reinfection. Recurrent CDI occurred in 32.7% of UC patients and 23.3% of Crohn's patients. CDI reinfection was observed in 36.6% of Crohn's patients and 26.2% of UC patients. Colonic involvement was documented in 100% (n = 14) of Crohn's patients with CDI recurrence and 81.8% (n = 18) of Crohn's patients with CDI reinfection. CDI recurrence and reinfection were not associated with gender, race, or the use of steroids, biologics, PPIs, opiates, or antibiotics. CONCLUSION: Compared to Crohn's patients, there was a greater proportion of UC patients who experienced recurrent CDI. Additionally, colonic involvement occurring in all Crohn's patients in this cohort with recurrent CDI suggests that the extent of colonic disease may predispose to recurrent CDI. Further investigation examining the incidence of recurrent CDI in Crohn's patients without colonic involvement is warranted. This study suggests that therapy with biologics, opiates, PPIs, and steroids are not risk factors for the development of CDI in IBD patients.