P1053 Clostridioides difficile Infection in Admitted patients with Ulcerative Colitis: Analysis of 23 Years through Propensity Score Matching

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Abstract Background Clostridioides difficile infection (CDI) represents the leading cause of nosocomial diarrhea in the Western world. Patients with ulcerative colitis (UC) have a higher risk of developing this infection, which has been associated with an increased risk of flare-ups, need for surgery, and mortality. The aim of the present study was to evaluate the impact of this infection in patients hospitalized for a UC flare-up. Methods Retrospective case-control study including all patients hospitalized for a UC flare-up at Reina Sofía Hospital in Córdoba between January 2000 and January 2023. To avoid potential selection biases, Propensity Matching Score (PMS) adjusted for age, gender, duration, and extent of the disease, with a 1:2 ratio was used. Primary objective was to assess the need for treatment intensification (initiation or dose escalation of biologics/small molecules or immunosuppressant). Secondary endpoints included readmission rate, colectomy, mortality, and CDI risk factors identification. Results During the study period, 419 patients were hospitalized for a UC flare-up, of whom 251 (59.9%) were men, with a median age of 41 (IQR 28-55) years and disease duration of 0.89 (0-5.8) years. Baseline characteristics of patients at admission are shown in Table 1. Of all admissions, 46 (11%) had CDI. After PMS, CDI was associated with increased therapeutic intensification between 3-12 months after discharge (27.5% vs. 11.7%, p = 0.004) and a higher risk of readmission at 12 months (37.5% vs. 13.7%, p = 0.009) but not to risk of colectomy or mortality (Table 2). Infection recurrence was detected in 8 (16.7%) patients. Classical risk factors for CDI were not found to increase the risk of CDI among UC patients, however antiTNF therapy was associated to CDI in both models: full cohort (OR 3.52, 95%CI 1.46-8.49) and PMS (OR 4.63, 95%CI 1.32-16.31). Conclusion CDI in UC was associated with a greater need for therapeutic intensification and a higher readmission rate at one year. There was no evidence of an increased risk of colectomy or mortality in these patients. Classical risk factors for CDI were not identified but patients on antiTNF were at higher risk of CDI.