P261 Co-infection of Clostridioides Difficile Aggravates Poor Outcomes in Inflammatory Bowel Disease with Cytomegalovirus Colitis

Abstract

Abstract Background Inflammatory bowel disease (IBD) prognosis is adversely affected by both Cytomegalovirus (CMV) colitis and Clostridioides Difficile (CD) infection. This is the first study in Asia to investigate the clinical impact and risk factors associated with their co-infection in IBD patients. Methods We conducted a retrospective cohort study at Linkou Chang Gung Memorial Hospital from January 2000 to May 2021, involving 53 IBD patients diagnosed with CMV colitis through colonic CMV immunohistochemistry staining. Based on stool toxin A/B tests, patients were divided into two groups: CMV only and CMV+CD co-infection. We compared baseline characteristics, clinical manifestations, risk factors, and outcomes between these groups. Logistic regression was used to analyze independent risk factors, and Kaplan-Meier methods evaluated cumulative incidence of remission rates. Results The study included 53 patients (37 in the CMV group and 16 in the Co-infection group). Diarrhea (93.8%) and abdominal pain (87.5%) were more prevalent in the co-infection group. Compared to the CMV group, the co-infection group had higher hospitalization times (2.5 vs. 1, p=0.005), more frequent CMV recurrences (1 vs. 0, p<0.001), and longer durations to achieve clinical (5 vs. 1 months, p<0.001), steroid-free (10 vs. 4 months, p=0.001), endoscopic (17.5 vs. 8.3 months, p=0.011), and histological remission (18 vs. 11 months, p=0.021) (Table 1-1). Kaplan-Meier analysis also indicated similar trends in Figure 1. The use of biologics was identified as an independent risk factor for co-infection (Odds Ratio 13.33, Confidence Interval 1.52-117.15, P=0.02) (Table 1-2). Conclusion Co-infection with CMV and CD in IBD patients leads to significantly worse outcomes. Early identification and aggressive treatment of co-infection in high-risk patients are vital for improving their prognosis.