P079 ISOLATION OF GASTROINTESTINAL PATHOGENS AFFECTS MEDICAL MANAGEMENT OF OUTPATIENTS WITH RELAPSE OF INFLAMMATORY BOWEL DISEASE

Abstract

Abstract Introduction Evaluating for the presence of gastrointestinal infection is a critical component of the workup for relapse of inflammatory bowel disease (IBD). With the advent of stool multiplex gastrointestinal pathogen panels (GI PCR), infections are increasingly identified. Prior research has shown that detection of enteric infection significantly affects the management of IBD in the inpatient setting. We aimed to characterize the impact of enteric infection detection on the management of IBD therapy in outpatients with relapse of IBD. Methods In a cross-sectional study of IBD outpatients at an academic medical center presenting with acute gastrointestinal symptoms from September 2015 to April 2019 who received GI PCR testing, we recorded pathogens detected, demographic data, biomarkers of inflammation, presenting symptoms, IBD subtypes, and IBD therapy. Our primary outcome was dose escalation in IBD therapy, defined as the addition of a new therapeutic agent or an increase in the dose or frequency of an existing medication. Secondary outcomes included rates of endoscopy, abdominal imaging, and antibiotics in the 30-day period after the initial visit and rates of adverse outcomes, i.e. emergency room (ER) visits, hospitalizations, and abdominal surgeries in the 90-day period after the initial visit. Results We identified 134 IBD outpatients tested with GI PCR. A pathogen was identified in 35 (26%) patients, of whom 9 (27%) had an increase in their medication regimen; 2 (22%) were prescribed an additional mesalamine, 3 (33%) a biologic, and none glucocorticoids. In contrast, 49/99 (45%, p=0.03) patients without an infection had an increase in their medication regimen, with 3 (7%, p=0.49) prescribed mesalamines, 11 (24%, p=0.67) biologics, and 7 (16%, p=0.04) glucocorticoids (Table 1). No patient received immunomodulators. Patients with an infection received more antibiotics (49% vs. 12%, p<0.01). They were also more likely to present with vomiting (11% vs. 3%, p=0.06) and undergo less post-visit endoscopy (6% vs. 16%, p=0.13), but these differences were near significant. There were no significant differences in demographics, initial IBD medications on testing, presenting symptoms, lab markers, abdominal imaging, or adverse outcomes. The most commonly isolated organisms were Escherichia coli subtypes, with 22/35 (63%) patients having at least one species isolated on testing (Table 2). Conclusion Detection of an enteric infection in outpatients with relapse of IBD was associated with significantly fewer dose escalations in IBD therapy, including glucocorticoids, and increased exposure to antibiotics, and a marginal decrease in endoscopy. These changes in management were not associated with a difference in adverse outcomes.