724 Does Zinc Deficiency in IBD Predispose Patients to Repeat C. difficile Infection?

Abstract

INTRODUCTION: Clostridiodes difficile infection (CDI) is the most common hospital-acquired infection in the United States. CDI is more common in patients with inflammatory bowel disease with a greater risk in ulcerative colitis patients compared to Crohn's disease patients. Recent literature revealed an association between decreased zinc levels and CDI via the activation of Th17 cells through the STAT3 pathway. We aimed to investigate the relationship of Zinc levels with the risk of recurrent CDI in IBD patients. METHODS: We performed an IRB retrospective cohort study of patients aged 18-75 with a history of IBD and a positive Clostridium Difficile PCR between January 1, 2012 and December 31, 2016 at a tertiary care center. A second CDI diagnosis within 3 months of the first was defined as recurrent CDI (rCDI). A second diagnosis after 3 months, but within 3 years of the first diagnosis was defined as reinfection. All charts were reviewed for zinc level testing at the time of any CDI. The primary outcome was zinc level at the time of primary diagnosis. This was also broken down by type of IBD. Descriptive statistics were calculated for the primary and secondary outcomes using SAS 9.4 (SAS Institute, Cary, NC). RESULTS: Of 121 patients with IBD and a positive C. difficile PCR, 23 patients had a zinc level tested. The average Zinc level among patients with only one CDI episode was 0.66, while it was 0.62 for rCDI and 0.62 for CDI reinfection. Of the 23 patients with a zinc level, 12 had Crohn's disease and 11 had Ulcerative Colitis. Only three Crohn's patients had one C difficile infection, four had rCDI, and six had C. difficile reinfection with average zinc levels of 0.66, 0.64, and 0.54 respectively. No ulcerative colitis patients only had a primary infection. The six UC patients with rCDI had an average zinc level of 0.64, while those with C. difficilereinfection had an average level of 0.72. CONCLUSION: While the sample size of this study was small, there is a trend for patients with Crohn's disease to have lower zinc levels if they have CDI reinfection compared to primary and rCDI. This could be explained by a sustained increase in the activation of Th17 cells via the STAT3 pathway in Crohn's patients with lower zinc levels. However, the patients with ulcerative colitis in this study did not have a tendency to have lower zinc levels suggesting that a different mechanism may be at play. Further investigation of this relationship in a larger study is required.