P0329 Clostridium difficile infection associates with the need for biologics: a retrospective long-term analysis in a cohort of 102 ibd patients

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Abstract Background Gastrointestinal Infections (GIs) pose a significant challenge in patients with inflammatory bowel diseases (IBD), complicating its management and triggering IBD relapses. The overlap in clinical symptoms makes complex differentiating GIs from IBD flares, impacting therapeutic decisions. This study aims at evaluating the long-term impact of GIs in IBD patients. Methods From January 2020 to September 2024, 102 IBD patients (mean age 45±16 yrs; 78 ulcerative colitis, UC and 24 Crohn’s disease, CD) experiencing a clinical relapse according to ECCO guidelines, were retrospectively evaluated. GIs were established via stool immunochromatography and multiplex molecular assay. Demographic, clinical and laboratory findings along with the treatment were noticed at the time of flare, 6 and 12 months later. Statistical analysis was performed by Mann-Witney and chi-square test as appropriate (p<0.05). Results Nineteen patients tested GIs positive (GIs+): 14 out of 78 (18%) UC and 5 out of 24 CD (21%) patients. Clostridium difficile infection (CDI) was found in 11 patients while non-CDI enteric pathogens (EP+) in the remaining 8 patients. All CDI patients received a first-line antibiotic treatment while no treatment was offered to EP+ patients. By stratifying for GIs at the flare time, there were no differences between GIs+ and GIs- patients with regard to age (45±16 vs46±17 yrs, p=ns), disease duration (11±9 vs 12±10 yrs, p=ns), disease activity score (Mayo score 5±2 vs 5±2, p=ns and Harvey Bradshaw index 8±4 vs 8±4, p=ns) and inflammation biomarkers (C-reactive protein 21±41 vs 22±42 mg/dl, p=ns and fecal calprotectin 1446±1751 vs 1452±1714 mcg/gr, p=ns). At 12 months after flare, the number of patients being treated with biologics increased only in GIs+ IBD patients, from 3 out 19 (16%) to 10 out 19 (53%) (Figure 1). All the 7 IBD patients who have got biologics were CDI+. Conclusion This study confirms that distinguishing a disease flare from the presence of superimposed GIs remains challenging. Notably, only in patients with CDI there was an increased use of biologics later after the flare onset. This suggest that CDI may serve as a marker of a more aggressive disease course in IBD patients.