S0743 Comprehensive National Inpatient Data Reveals Low Pneumocystis Risk in IBD Patients

Abstract

INTRODUCTION: Pneumocystis pneumonia (PCP) is a life-threatening opportunistic infection associated with impaired cell-mediated immunity. Immunosuppressive medications and inflammatory conditions are known to increase the risk of PCP infection, but limited data exists to guide management of risk for inflammatory bowel disease (IBD) patients. We evaluated the frequency of admissions for PCP in this cohort and the potential contribution of non-IBD risk factors. METHODS: The national inpatient sample (NIS) from 2016 to 2017 was queried for all admissions involving both PCP pneumonia and patients who have either Crohn’s or Ulcerative Colitis (UC). Demographic data, reason for admission, and inpatient outcomes were evaluated among PCP patients with and without IBD. A multivariate logistic regression was used to evaluate additional risk factors in the IBD inpatient population for PCP development. RESULTS: There were an estimated 225 admissions involving PCP among patients with IBD from 2016 to 2017 nationwide, representing a total of 0.035% of admissions for this cohort (Table 1). IBD patients with PCP were far more likely to die (15.6% vs 1.5%, P = 0.015), be male (55.6% vs 43.7%, P = 0.117) and have prolonged length of stay (16.8 vs 5.3 days average, P < 0.001). HIV (20% vs 0.5%, P = 0.003), other immune conditions (28.9% vs 2.6%, P < 0.001), and chronic steroid use (15.6% vs 6.4%, P = 0.10) were far more common in the patients who developed PCP, and overall 64.4% had at least one additional comorbidity (Table 2). All three factors were strong predictors in the multivariable regression adjusted for the Elixhauser comorbidity score and age (Table 3). CONCLUSION: National admissions data indicates PCP is very rare in IBD patients. At least 64% of patients with PCP have at least one additional risk factor. Therefore, patients with inflammatory bowel disease do not need to be considered for PCP prophylaxis unless an additional risk factor is present.Table 1.: Summary of Patient and Hospital Characteristics for IBD Patients Stratified By Pneumocystis Pneumonia StatusTable 2.: Summary of Concurrent Risk Factors Present Among IBD Patients Stratified By Pneumocystis Pneumonia StatusTable 3.: Predictors of PCP Infection among Inflammatory Bowel Disease and Non-Inflammatory Bowel Disease Patients