S3197 Impact of Disease Severity and Time-to-Test for Clostridioides difficile Infection on Length of Stay in Inflammatory Bowel Disease Patients Hospitalized With Flare

Abstract

INTRODUCTION: Guidelines recommend testing inflammatory bowel disease (IBD) patients hospitalized with flare for Clostridioides difficile infection (CDI), though little is known about whether a delay in testing for CDI is related to adverse outcomes. We examined the relationship between time to C. difficile PCR test order, collection, and result with adverse IBD outcomes. METHODS: We performed a retrospective cohort study of IBD patients hospitalized with flare through the emergency department (ED) between 2013 and January 2020 at an urban academic medical center. The time from ED presentation to CDI test order (time-to-order), sample collection (time-to-collection), and test result (time-to-result) were collected. Time-to-result was stratified by within 6 hours, 6–24 hours, and 24 hours or longer. The primary outcome was length of stay (LOS). Secondary outcomes were inpatient anti-TNF administration and surgery. Separately, we used initial hemodynamic and laboratory values to create an IBD hospitalization severity score for evaluation against LOS and time-dependent variables. RESULTS: We identified 122 IBD patients hospitalized with flare. There were no significant differences in baseline characteristics among time-to-result groups. There was no difference in time-to-order between the 6 hours and 6–24 hours groups (Table 1). Despite a shorter time-to-result, the average LOS in the 6 hours group was 7.3 days, longer compared to the 6–24 hours group (4.3 days, P = 0.018) and the 24 hours group (4.2 days, P = 0.035; Table 1). There were no differences in inpatient anti-TNF administration (P = 0.10) or surgery (P = 0.08) among time-to-result groups. Markers of disease severity correlated with longer LOS and earlier time-to-result (Table 2). A composite of these markers was used to stratify patients by disease severity. Those with more severe disease had earlier times-to-result (12.8 hours vs. 32.2 hours, P = 0.014) and had a longer LOS (7.9 vs. 3.4 days, P = 0.007) with no difference in time-to-order compared to patients with less severe disease (P = 0.09; Table 3). CONCLUSION: Earlier time-to-result for CDI is associated with longer LOS in IBD patients hospitalized with flare. This inverse relationship is confounded by disease severity at presentation. Patients with more severe disease have a shorter time-to-result and a longer LOS without any difference in time-to-order. Delay in testing was not associated with higher rates of inpatient anti-TNF administration or surgery.Table 1.: Length of stay is longer in those tested for CDI within 6 hours of presentation compared to those tested after 6 hours. P-value as compared to < 6h group in parentheses.Table 2.: Correlation of markers of disease severity with length of stay and/or time-to-result.Table 3.: Comparing time-to-order, time-to-collection, time-to-result, and length of stay using a composite of severity (CRP >= 10, HR >= 100, diastolic blood pressure <60, or albumin <3.5). P-value for statistical significance in comparison to 1 Marker group in parentheses.