S196 Clostridioides difficile Infection (CDI) Increased in Individuals Diagnosed With Prior Colorectal Adenomas

Abstract

Introduction: Clostridioides difficile infection (CDI) is increased in patients with colorectal cancer, but no one has investigated if CDI is also higher in individuals with prior history of colorectal adenomas seen on colonoscopy. Methods: We conducted a hospital-based cohort study composed of patients with diarrhea admitted to University of Michigan from 3/2016 to 12/2017 who were tested for C. difficile. Two hundred ninety-six diagnosed with C. difficile and 571 with non-C. difficile diarrhea were enrolled into the larger study. We abstracted prior colonoscopy reports and pathology reports from the medical records. Patients who had undergone colonoscopy were included in this analysis. Six hundred forty-seven underwent colonoscopy and 111 were diagnosed with colorectal adenomas prior to enrollment in the study. Logistic regression models were used to derive odds ratios (ORs) and 95% confidence intervals (95% CI) to evaluate comparisons between cases diagnosed with C. difficile and non-C. difficile diarrhea controls. We analyzed the association between history of colorectal adenoma diagnosis and CDI. (Figure, Table) Results: We found an increased risk of CDI in individuals with a prior colorectal adenoma (HR 1.64; 95% confidence interval (CI) 1.06-2.54) after adjusting for age, sex, obesity, complicated and uncomplicated diabetes and inflammatory bowel disease. Notably we also found a significant decreasing association between time since polypectomy and CDI with greater risk associated with greater time since colonoscopy. Conclusion: This study showed a higher incidence of CDI in individuals with a prior history of adenoma.Risk decreases over time since last polypectomy, which lends support to the hypothesis that there is a link between adenomas and subsequent CDI risk. Futures studies are needed to confirm this finding and elucidate mechanisms as this relationship could help target prophylactic measures in these individuals to avoid future infection.Figure 1.: Risk factors of CDI estimated with multivariate logistic regression. Model was adjusted for Complicated DM, Obesity, gender, history of adenoma, and age Table 1. - Baseline characteristics of subjects by Clostridioides difficile infection (CDI) diagnosis 1. Clostridioides difficile infection (CDI), Diabetes mellitus (DM) 2. Pearson's Chi-squared test; Fisher's exact test. 3. Interquartile range (IQR). 4. n (%) Characteristic Non-CDI1 Diarrhea (N=422) CDI1 Diarrhea (N=225) p-value2 Age 53 (39, 64)3 55 (45, 69)3 0.6 Non-Hispanic Caucasian 337 (80%)4 178 (79%)4 0.8 History of adenoma 58 (14%)4 53 (24%)4 0.002 Gender 0.11 Female 249 (59%)4 118 (52%)4 Male 73 (41%)4 107 (48%)4 Obesity 43 (10%)4 34 (15%)4 0.07 IBD 155 (37%)4 57 (25%)4 0.003 Complicated DM1 42 (10.0%)4 48 (21%)4 < 0.001