Mo1387 Is a History of Gastrointestinal Surgery a Risk Factor for an Increased Incidence of Clostridium difficile Infection in Patients With Inflammatory Bowel Disease?

Abstract

Background: Antibiotic use is the most widely recognized risk factor for Clostridium difficile infection (CDI). Other established risk factors include hospitalization, advanced age, severe illness, inflammatory bowel disease (IBD), and possibly gastrointestinal surgery. Although studies have reported a higher prevalence of CDI in IBD patients, there is a paucity of data examining the incidence of CDI in patients who have received surgical intervention for IBD. Aim: The aim of this study is to investigate the incidence of CDI in patients with IBD who never had gastrointestinal surgery compared to patients with IBD who underwent disease related surgical intervention. We theorize that patients who have had surgical intervention for IBD are more prone to CDI due to greater severity of disease, more frequent hospitalizations, and increased exposure to antibiotics. Methods: Data was retrieved from Albany Medical Center's electronic records to conduct a retrospective chart review of patients with Crohn's disease and ulcerative colitis from the years 2000-2012. Parameters studied included type of surgery, result of Clostridium difficile toxin testing, age at surgery related to IBD, age at CDI positivity (if applicable), and gender. Patients with IBD who never had testing for CDI were excluded. Results: 1434 patients were identified with IBD. After inclusion criterion was met, 908 patients with Crohn's disease and 104 patients with ulcerative colitis were studied. The data is summarized in the tables below. Among patients with Crohn's disease, 48 were found to be positive for CDI out 506 patients with a history of gastrointestinal surgery for IBD (9.49%). 60 patients were found to be positive for CDI out of 402 patients without a prior surgical history related to IBD (14.92%). P value = 0.8869. Among patients with ulcerative colitis, 2 patients were found to be positive for CDI out of 16 patients with a history of prior gastrointestinal surgery related to IBD (12.5%). 7 patients were found to be CDI positive out of 88 patients without a prior surgical history related to IBD (7.95%). P value = 0.4478. Conclusion: Crohn's disease and ulcerative colitis are chronic relapsing inflammatory conditions that require long term medical therapy, periodic hospitalizations, and even surgery. Chronic use of antibiotics and immunosuppressants has been shown to increase the risk of CDI in IBD patients. CDI has been reported in ulcerative colitis patients with restorative protocolectomy and ileal pouch anal anastomosis. Our data shows that surgery did not appear to increase the incidence of CDI in patients with Crohn's disease or ulcerative colitis. Crohn's Disease Patients