Positive Stool Test Research Articles

Adenoma Detection Rate after Positive Stool-Based Screening in a U.S. Population

Abstract Introduction and Objectives Over the past two decades, advancements in screening programs have led to a decrease in the incidence and mortality rates of colorectal cancer. The recommended benchmark for primary screening colonoscopy adenoma detection rate (ADR) is 25%. However, recent research supports higher ADR benchmarks following positive stool testing. Findings from a Dutch screening program have suggested higher ADRs in fecal immunochemical test positive patients with an inverse relationship with interval cancer development. Our study aims to assess ADRs in a U.S. patient population with positive stool screenings and investigate any correlation to occurrences of interval cancers. Materials and Methods Data from all positive stool-based screening participants who subsequently underwent colonoscopy at a tertiary care center between 2017 and 2021 were collected. A retrospective chart review was performed to determine the ADR and interval colon cancers. Results From a total of 120 patients (32 fecal occult blood test [FOBT] positive patients, 43 fecal immunochemical test [FIT] positive patients, 45 FIT-DNA-positive patients), the average ADR was 35%. Nonadvanced polyps were the most identified adenomas at 78.6%. No interval colorectal cancer cases were identified. There was a clear difference in ADR between stool-testing methods, with FIT-DNA showing higher ADRs than FIT and FOBT. Conclusion Endoscopists should recognize the importance of higher ADR targets in colonoscopies conducted after positive stool-based screening as a means to maintain high-quality colonoscopy standards.

Perceptions of the Impact of Comorbidity on the Bowel Cancer Screening Programme: Qualitative Study With Bowel Screening Participants and Staff.

The impact of multiple health conditions on bowel cancer screening is currently unknown. We explored the impact of multiple health conditions on bowel cancer screening perceptions, experience and clinical management decisions following a positive stool test. Semi-structured qualitative interviews were conducted remotely with Bowel Screening Wales staff (n = 16) stratified by regional location and roleand with screening participants (n = 19) stratified by age, gender and comorbidity. Interview topics were guided by the Common-Sense Model. Screening participants, regardless of comorbidity status, placed great emphasis on the importance of early detection of cancer and completing the bowel screening process. Screening staff emphasised comorbidities in the clinical decision-making process; however, screening participants had low awareness of the impact that comorbidities can have on bowel screening. Participants describe how the presence of multiple health conditions can mask potential bowel symptoms and influence beliefs about follow-up. Bowel screening staff try to individualise the service to meet participant needs. The potential mismatch in screening staff and participant awareness and expectations of the bowel screening and diagnostic process needs to be addressed. Clearer and more regular communication with screening participants could support the screening process, particularly for those with significant coexisting health conditions or facing time delays. The possible masking effects and misattribution of symptoms because of comorbidities highlightan opportunity for education and raising awareness for screening participantsand a potential area of focus for discussions in clinical consultations and staff training. Project funding included costs for patients and public contributors to be compensated for their contributions to the project, in line with current standards. A patient and public contributor was involved in the design of the study, including protocol development, and the interpretation of key findings and implications for patients, which are subsequently reflected within the manuscript.

Analysis of the relationship between intestinal segmented filamentous bacteria and rotavirus infection in children

Objective: To investigate the association between intestinal colonization of segmented filamentous bacteria (SFB) and the risk of rotavirus infection, and the possible mechanisms by which SFB resist rotavirus infection. Methods: This case-control study enrolled 50 children aged 0 to 5 years who present to the outpatient Department of Children's Hospital, Zhejiang University School of Medicine with diarrhea and positive stool tests for rotavirus. The children were divided into rotavirus enteritis group and control group consisting of 55 children with non-gastrointestinal and non-infectious surgical diseases.The age and sex composition of the two groups was matched. The DNA of the fecal flora was extracted and SFB was detected by real-time fluorescence quantitative PCR analysis. The children in the rotavirus enteritis group and the control group were subgrouped by age and sex to analyze the differences in SFB positivity rates between different groups, and further compare and analyze the differences in SFB positivity rates between these two groups of children in the ≤2 years old subgroup and the >2-5 years old subgroup. Neutralization test was performed with p3340 protein and rotavirus to determine the relationship between rotavirus infection rate and p3340 concentration in Vero cells. χ2 test or Fisher's exact probability method was used for comparison between the two groups. Results: There were 50 children in the rotavirus enteritis group with an age of (1.7±0.9) years, and 55 children in the control group with an age of (1.8±1.1) years. The positive rate of SFB in children with rotavirus enteritis showed a declining trend across ages groups, with the highest rate of 10/14 in the ≤1 year old group, followed by 67% (14/21) in the >1-2 years old group, 9/15 in the >2-5 years old group, and there was no statistically significant difference (P=0.867). The positive rate of SFB in the control group was 12/15 in the ≤1 year old group, 95% (19/20) in the >1-2 years old group, 50% (10/20) in the >2-5 years old group, with statistical significance (P=0.004). The positive rate of SFB in children with rotavirus enteritis was 74% (20/27) in males and 56% (13/23) in females (χ2=1.71, P=0.192). In the control group, it was 79% (22/28) in males and 70% (19/27) in females (χ2=0.49, P=0.485). The positive rate of SFB was 66% (33/50) in the rotavirus enteritis group and 75% (41/55) in the control group, with no statistically significant (χ2=0.56, P=0.454). In the children ≤2 years old, the SFB positivity rate was 69% (24/35) in the rotavirus enteritis group and 89% (31/35) in the control group, with a statistically significant difference (χ2=4.16, P=0.041). However, in the children >2-5 years old, no statistically significant difference was observed, with the positive rate of SFB being 9/15 in the rotavirus enteritis group and 50% (10/20) in the control group (P=0.734). Pearson correlation analysis revealed a negative correlation between rotavirus infection and SFB positivity (r=-0.87,P<0.001). As the concentration of the p3340 specific protein increased, the luminescence intensity of the luciferase in the Vero cells, which were suitable for cultivating rotavirus, exhibited a decreasing trend (F=4.17, P=0.001). Conclusions: SFB colonization in infants less than 2 years old is associated with a reduced risk of rotavirus infection. Cloning of specific SFB functional protein p3340 neutralizes rotavirus infection of Vero cells, and this mechanism of targeting rotavirus infection differs from the common antiviral mechanism.

Association of Endoscopist Colonoscopy Quality Measures With Follow-Up Colonoscopy Outcomes After Positive Stool Tests (Multitarget Stool DNA or Fecal Immunochemical Test): Retrospective Cross-Sectional Analysis of Data From the New Hampshire Colonoscopy Registry.

Negative colonoscopies following positive stool tests could result from stool test characteristics or from the quality of endoscopist performance. We used New Hampshire Colonoscopy Registry data to examine the association between endoscopist detection rates and polyp yield in colonoscopies performed for positive fecal immunochemical test (FIT) or multitarget stool DNA (mt-sDNA) test to evaluate the degree to which positive stool tests followed by negative colonoscopy ("false positives") vary with endoscopist quality. In addition, we investigated the frequency of significant polyps in the subgroup of highest quality colonoscopies following positive stool tests. We compared the frequencies of negative colonoscopies and of specific polyps following positive stool tests across quartiles of endoscopist adenoma detection rate (ADR) and clinically significant serrated polyp detection rate (CSSDR). Our sample included 864 mt-sDNA+ and 497 FIT+ patients. We found a significantly lower frequency of negative colonoscopies following positive stool tests among endoscopists with higher ADR and CSSDR, particularly in the 2 highest quartiles. In addition, detection of any adenoma after a positive stool test for endoscopists in the fourth ADR quartile was 63.3% (FIT+) and 62.8% (mt-sDNA+). Among endoscopists in the fourth CSSDR quartile, sessile serrated lesions were found in 29.2% of examinations following a positive mt-sDNA and in 13.5% following FIT+ examinations. The frequency of negative colonoscopies after positive stool tests was significantly higher in examinations performed by endoscopists with low ADR and CSSDR. Our results also suggest a benchmark target of at least 40% for ADR in patients with mt-sDNA+ or FIT+ tests and 20% for sessile serrated lesions in mt-sDNA+ patients.

S730 Higher Rates of Endoscopic Mucosal Resection (EMR) in Colonoscopy Following Positive Stool Test vs Average Risk Screening

S730 Higher Rates of Endoscopic Mucosal Resection (EMR) in Colonoscopy Following Positive Stool Test vs Average Risk Screening

Clinical Practice Guidelines of the Scientific Society for the Clinical Study of Human Microbiome, of the Russian Gastroenterological Association and the Russian Society for the Prevention of Noncommunicable Diseases on the Diagnosis and Treatment of &lt;i&gt;Clostridioides difficile&lt;/i&gt; (&lt;i&gt;C. difficile&lt;/i&gt;)-associated Disease in Adults

Аim: the clinical practice guidelines intended for gastroenterologists, internal medicine specialists, infectious disease specialists, general practitioners (family doctors), coloproctologists, surgeons and endoscopists present modern methods of diagnosis, prevention and treatment of C. difficile-associated disease.Key points. C. difficile-associated disease is a disease that develops when the diversity of the intestinal microbiota decreases and C. difficile excessively colonizes the colon, the toxins of which damage the intestinal muco-epithelial barrier, followed by the development of inflammation in the colon wall, with diarrhea being a characteristic clinical manifestation. The clinical presentation of the disease can vary from asymptomatic carriage, mild to moderate diarrhea that resolves on its own, to profuse watery diarrhea and pseudomembranous colitis with development of life-threatening complications. The diagnosis of C. difficile-associated disease is based on an assessment of the clinical presentation, medical history, an objective examination of the patient and laboratory stool tests. The disease severity is determined by clinical symptoms and laboratory findings. Additional diagnostic methods that are used according to indications and contribute to the assessment of severity include endoscopy of the colon and abdominal cavity imaging methods. Treatment should be initiated in cases of characteristic clinical presentation of C. difficile-associated disease and positive laboratory stool testing. The choice of drug and treatment regimen depends on the severity of the episode, the presence of complications, and whether the episode is initial, recurrent, or reinfection.Conclusion. Determination of target groups of patients for the diagnosis of clostridial infection is important in preventing overdiagnosis and subsequent unnecessary treatment. Timely diagnosis and treatment of C. difficile-associated disease help avoiding the development of life-threatening complications and improve the prognosis and quality of life of patients.

What do ‘false-positive’ stool tests really mean? Data from the New Hampshire colonoscopy registry

We utilized the population-based New Hampshire Colonoscopy Registry to calculate false discovery rates (FDR) and positive predictive values (PPVs) using three ‘positive’ colonoscopy definitions. Understanding the frequency of meaningful ‘true positive’ mt-sDNA and Fecal Immunochemical Test (FIT) results can optimize the use of these colorectal cancer (CRC) screening tests. We calculated FDR (positive stool test followed by negative colonoscopy divided by all positive stool tests) and PPV for mt-sDNA and FIT cohorts using the following definitions:1) DeeP-C Study (CRC, adenomas/serrated polyps ≥ 1 cm, villous/High Grade Dysplasia);2) < 10 year US Multi-Society Task Force (USMSTF) follow-up: DeeP-C findings & ≥1 sessile serrated polyps (SSPs) < 1 cm (with/without dysplasia) or ≥ 1 tubular adenomas < 1 cm.3) Clinically Significant: DeeP-C + USMSTF + clinically significant serrated polyps: traditional serrated adenomas, SSPs, hyperplastic polyps (HPs) > 1 cm, and 5–9 mm proximal HPs.The sample included 549 mt-sDNA + and 410 FIT + and patients (mean age 66.4, 43.0% male). Using the most limited definition of positive colonoscopy, DeeP-C, FDR was 71.9% for mt-sDNA + and 81.7% for FIT +. Using the USMSTF definition, FDR decreased substantially: mt-sDNA+:33.2% and FIT+:47.6%. Adding all CSSPs resulted in the lowest FDR: mt-sDNA+:32.2% and FIT+:47.1%. Decreasing FDRs corresponded to increasing PPVs: mt-sDNA+:28.1% and FIT+:18.3% (DeeP-C definition) and mt-sDNA+:67.8% and FIT+:52.9% (DeeP-C + USMSTF + CSSP) (Table 1).FDRs decreased substantially when the definition of positive exams included all significant precancerous findings. These data present a comprehensive understanding of false positive outcomes at colonoscopies following positive stool tests, which to our knowledge is the first such analysis.

Point-of-care isoenzyme type M2 pyruvate kinase quick stool test for the detection of gastric cancer in Rwanda: A pilot study.

e18530 Background: Isoenzyme type M2 pyruvate kinase (M2-PK) can only be detected in gastrointestinal (GI) tumors. Detection of M2-PK on a small, portable platform with minimal training required, could offer a streamlined approach for the diagnosis of GI cancers especially in low-income countries (LIC's). We evaluated the feasibility of M2-PK stool test to detect gastric cancer in Rwanda. Methods: Participants with GI symptoms were screened and scheduled for upper endoscopy during the 5th Annual Rwanda Endoscopy Week. Participants who underwent gastric biopsy and provided a stool sample were enrolled. Three Rwandan medical centers participated. ScheBo M2-PK Quick test (Biotech AG, Giessen, Germany) was used to test fecal tumor M2-PK. Study approval was obtained from Dartmouth Health, UConn Health, and University of Rwanda IRB's. Descriptive statistics were estimated. Study is currently enrolling patients to reach the desired sample size (N = 110). Results: A total of 35 patients were consented; 26 patients did not have a biopsy, 1 did not provide a stool sample, 1 was lost to follow-up, and 7 were analyzable. 57.1% were male (n = 4) and 42.9% females (n = 3) with ages ranging from 50 to 71 years old. Males accounted for 66.6% of the cases of gastric cancer (n = 2). The most predominant symptoms reported were dyspepsia (66.7%), and weight loss (33.3%). Among those with hemoglobin levels available the mean was 8.63 g/dL (SD ± 0.71). Only one patient completed staging imaging with CT scans. Two patients with positive M2-PK stool tests had a proven diagnosis of gastric cancer (100%). One of them had a diagnosis of GIST. There was only 1 confirmed gastric adenocarcinoma in 5 patients with a negative M2-PK stool test, yet two patients were told to repeat the endoscopy procedure. Conclusions: A point-of-care (POC) quick stool test to screen gastric cancer is feasible in Rwanda. Study participation interest was high among Rwandan patients. Due to a lack of flexible endoscopes in LIC's, screening is restricted to patients living near regional or urban endoscopy centers, which contributes to the growing prevalence of gastric cancer and health disparities. Cancer control programs in LIC's can be implemented and maintained iteratively with realistic expectations and interventions tailored to the local population, its cultural values, and economic infrastructure. Thus, an emerging POC M2-PK stool test can triage patients to early medical attention when suspected gastric cancer.

170. Comparison of Traditional Stool Culture and Targeted Testing Using Multiplex PCR to Diagnose Infectious Diarrhea at the Atlanta VA Medical Center (AVAMC): A Diagnostic Stewardship Initiative.

Abstract Background Multiplex PCR panels have become common for diagnosing infectious diarrhea; however, indiscriminate use of multiplex PCR panels may identify common pathogens that do not require treatment. To optimize laboratory workflow and improve diagnostic stewardship, we developed a targeted algorithm to optimize multiplex PCR testing at the AVAMC. We retroactively applied the targeted algorithm to historical stool cultures to assess the potential impact on diagnosis, inappropriate test ordering, and cost. Figure 1Targeted Algorithm for Testing Infectious Diarrhea Methods In March 2022, multiplex PCR testing (Biofire) was initiated at AVAMC; we developed a targeted algorithm to inform testing of patients at highest risk from infectious bacterial diarrhea (Figure 1). We retrospectively reviewed all clinical information among patients with bacterial stool testing, which included cultures and antigen tests, obtained from January 1, 2019 to December 31, 2021. In our analysis, we included all patients with a positive stool culture and a random sample of patients with a negative stool culture. We applied the targeted algorithm to both retrospective cohorts in order to evaluate potentially missed cases, outcomes, and overall differences in costs and labor between traditional stool cultures and targeted multiplex PCR testing. Results We identified 1027 patients with bacterial stool testing. Among 27 patients with a positive stool test, the targeted algorithm missed testing among 6 (22%) patients with mild, self-limited disease that resolved within 7 days. Among 100 patients with negative stool cultures, the targeted algorithm excluded testing among 75 (75%) patients. Among the remaining 25 (25%) negative patients who would have been tested using the targeted algorithm, 14 (56%) were high-risk and 16 (64%) had severe illness. Eliminating unnecessary stool testing using a targeted algorithm would have saved an estimated $50,000 and 750 laboratory labor hours. Conclusion At our facility, the implementation of algorithm-guided infectious diarrhea testing by multiplex PCR is estimated to reduce laboratory time and materials costs while eliminating 75% of unnecessary testing. Algorithm-guided testing would capture the majority of bacterial diarrhea at our institution but could lead to missed diagnoses in lower-risk populations. Disclosures All Authors: No reported disclosures.

400. Rehospitalization of Patients for Recurrent Clostridioides difficile Infection

Abstract Background Clostridioides difficile infection (CDI) is an important cause of morbidity and mortality, especially in patients with recurrent episodes and those requiring re-hospitalization. Decreasing recurrent CDI (rCDI) and re-hospitalization for rCDI are important outcomes. The purpose of our study was to evaluate the impact of specialty care from an infectious disease (ID) or gastroenterology (GI) provider, either during the admission of the primary episode or in a follow-up appointment within 30 days. Methods This was a single-center, retrospective, chart review at a tertiary medical center. All hospitalized patients with a positive stool test for C. difficile (CD) (GI panel PCR, FilmArray, Biofire, or CD PCR, Xpert CD assay, Cepheid) with or without an ICD-10 code Enterocolitis due to CD (A04.7, A04.71, A04.72) from January 2018 through December 2018 were reviewed. Demographic and clinical data at the time of diagnosis and up to 90 days after discharge were collected. Results Our criteria identified 602 patients. We excluded 27 patients who died while hospitalized and 104 patients classified as colonized from analysis. Most patients (410/471, 87%) were determined to have a primary CDI episode. After discharge, 57 (14%) patients developed rCDI and 40 patients (10%) died within 90 days of discharge. Among those with rCDI, 40% (23/57) of patients had to be re-hospitalized due to their recurrence. Those re-hospitalized for rCDI developed their recurrence sooner (40% within 45 days, p &amp;lt; 0.005) compared to patients with rCDI that were not re-hospitalized (Figure). ID/GI evaluated 173 of 471 (37%) patients during the index hospitalization or on hospital follow-up. Among patients evaluated by ID/GI, 10.4% had rCDI compared to the 13.8% with no ID/GI intervention. (p=NS). Only 3.5% (6/173) of patients evaluated by ID/GI were re-hospitalized vs 5.7% (17/298) of patients without ID/GI evaluation. (p=NS) Time to CDI recurrence in re-hospitalized patients Conclusion In our study, 40% of patients who had rCDI had to be readmitted for their rCDI. Recurrence occurred significantly earlier in patients who were re-hospitalized. Patients evaluated by ID or GI had a decreased rate of re-hospitalization. Inpatient consultation and timely follow up of hospitalized CDI patients should be studied prospectively to determine the impact on rCDI re-hospitalization. Disclosures Stuart Johnson, M.D., Ferring Pharmaceuticals: Membership on Ferring Publication Steering Committee|Ferring Pharmaceuticals: Employee|Summit Plc: Advisor/Consultant.

2008. Real-World Experience of Administration of Bezlotoxumab in an Outpatient Infusion Center Upon Discharge in Recurrent Clostridioides difficile patients

Abstract Background Bezlotoxumab is a humanized monoclonal antibody administered as single IV infusion that binds to Clostridioides difficile toxin B. It is currently recommended as a co-intervention in the updated 2021 IDSA guidelines for patients with recurrent C. difficile infection (CDI) in the last 6 months in addition to standard of care (SOC) antibiotics (vancomycin or fidaxomicin) to decrease CDI recurrence. Due to logistical issues and cost restrictions, administration is difficult as part of the inpatient stay. This case series evaluated a novel practice of discharging patients to receive bezlotoxumab immediately upon discharge from our not-for-profit community health system. Methods This was a retrospective chart review of all adult patients who received an outpatient infusion of bezlotoxumab after discharge between June 2019 and January 2022 for recurrent CDI. CDI was defined as ≥ 3 loose stools within 24 hours and a positive stool test for toxigenic C. difficile. The primary objectives were to evaluate the safety of bezlotoxumab in the outpatient setting and the rate of recurrent CDI at 12 weeks and 1 year. Recurrent CDI was defined using the same parameters as initial infection. Results Ten patients received bezlotoxumab in the outpatient setting after discharge and were included. Of the 10 patients, 2 were immunocompromised, 6 had at least stage 2 chronic kidney disease, and 4 required dialysis. All patients had &amp;gt; 1 previous CDI in the past 6 months, ranging between 1-6 with the average being 2.4. The average time to infusion was 9.8 days after starting SOC antibiotics and 80% of patients received treatment within 24 hours of discharge. No patients reported adverse reactions during treatment. One patient with a previous diagnosis of heart failure was readmitted for a heart failure exacerbation 69 days after receiving bezlotoxumab. Two patients and 4 patients experienced CDI recurrence within 12 weeks and 1 year of infusion, respectively. Conclusion Discharging patients to receive bezlotoxumab as an outpatient infusion is a safe and effective way to treat recurrent CDI logistically and may offer a financial advantage to institutions to shift costs to an outpatient payment model. Recurrence rates compared to phase III trials of bezlotoxumab were similar at 12 weeks (20% vs. 16%). Disclosures Christopher M. Bland, PharmD, FCCP, FIDSA, BCPS, biomerieux, Inc.: Honoraria|Merck Pharmaceuticals: Advisor/Consultant|Merck Pharmaceuticals: Honoraria Bruce M. Jones, Pharm.D., FIDSA, BCPS, AbbVie: Advisor/Consultant|AbbVie: Honoraria|La Jolla: Honoraria|Melinta: Advisor/Consultant|Paratek: Honoraria|Regeneron: Honoraria.

S266 Lifetime Impact of the Change in Modality as a Result of Eliminating Cost-Sharing for Follow-Up Colonoscopy After a Positive Stool Test for Colorectal Cancer Screening

S266 Lifetime Impact of the Change in Modality as a Result of Eliminating Cost-Sharing for Follow-Up Colonoscopy After a Positive Stool Test for Colorectal Cancer Screening

S337 Colonoscopy Quality Metrics After a Multi-Target Stool DNA or Fecal Immunochemical Test: A Systematic Review and Meta-Analysis

Introduction: Colorectal cancer (CRC) accounts for approximately 50,000 deaths or 14 deaths per 100,000 people yearly in the United States. Multi-target stool DNA (mt-sDNA) and fecal immunochemical test (FIT) are validated CRC screening strategies in average-risk asymptomatic individuals. This study aims to evaluate the colonoscopy quality metrics following a positive mt-sDNA test, FIT. Methods: We performed a comprehensive search in the databases of PubMed/MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials from inception through May 2022. Meta-analysis was performed by standard methodology using the random-effects model and heterogeneity was assessed using the I2% statistics. Outcomes of interest were adenoma detection rate (ADR), colorectal cancer detection rate (CRCDR), withdrawal time (WT), and cecal intubation rate (CIR). Results: 27 high-quality studies (97825 patients) were included in the analysis. 94161 had a positive FIT test in 23 studies and 3664 had positive mt-sDNA in 4 studies. The pooled WT after positive mt-sDNA was 16.1 minutes (95% CI 9.4-22.8, I2=99%), whereas after positive FIT was 11.6 minutes (10.9-12.3, 99%). The corresponding WT in the negative tests was 13.2 minutes (12.7-13.7) for mt-sDNA and 10.2 minutes (9.3-11.2) for FIT. The pooled ADR was 73% (69.9-75.8) and CRCDR was 1.9% (0.9-4.2) in mt-sDNA positive. The pooled ADR was 54.2% (49.8-58.4) and pooled CRCDR was 4% (3.2-4.9) in FIT positive. Pooled CIR were excellent: 99% (98.6-99.3) in mt-sDNA positive, and 96.8% (95.8-97.6) in FIT positive. Pooled rates are summarized in Table. Conclusion: Our meta-analysis demonstrated that positive mt-sDNA or FIT patients had a higher WT and CIR when compared to negative or unknown tests. ADR and CRCDR were high, however, it is not known if it is secondary to positive stool test or to longer WT. Future studies are needed to validate our findings and determine the cost-effectiveness of these screening tests. Table 1. - Colonoscopy quality metrics including withdrawal time, cecal intubation rate, adenoma detection rate and colorectal cancer detection rate after positive and negative multi-target stool DNA and fecal immunochemical test testing Outcomes Multi-target stool DNA (mt-sDNA) Fecal Immunochemical Test (FIT) Withdrawal time (WT), mean (95%CI) Positive: 16.1 (9.4-22.8) (SE: 3.4);4 studiesNegative: 13.2 (12.7-13.7) (SE: 0.2)1 study Positive: 11.6 (10.9-12.3) (SE: 0.3);22 studiesNegative: 10.2 (9.3-11.2) (SE: 0.5)6 studies Cecal intubation Rate (CIR), pooled rate (95%CI) Positive: 99% (98.6-99.3)2 studies Positive: 96.8% (95.8-97.6, 94%)12 studies Adenoma Detection Rate (ADR), pooled rate (95%CI) Positive: 73% (69.9-75.8)1 studyNegative: NR Positive: 54.2% (49.8-58.4, 97%)20 studiesNegative: 35.1% (30.5-39.9, 95%)6 studies Colorectal Cancer Detection Rate (CRCDR), pooled rate (95%CI) Positive: 1.9% (0.9-4.2, 81%)3 studiesNegative: 7.9% (2.6-21.8)1 study Positive: 4% (3.2-4.9, 88%)17 studiesNegative: 0.5% (0.2-1.6, 85%)5 studies Abbreviations: NR: not reported, SE: standard error, CI: confidence interval.

Analysis of SARS-CoV-2 viral loads in stool samples and nasopharyngeal swabs from COVID-19 patients in the United Arab Emirates

Coronavirus disease 2019 (COVID-19) was first identified in respiratory samples and was found to commonly cause cough and pneumonia. However, non-respiratory symptoms including gastrointestinal disorders are also present and a big proportion of patients test positive for the virus in stools for a prolonged period. In this cross-sectional study, we investigated viral load trends in stools and nasopharyngeal swabs and their correlation with multiple demographic and clinical factors. The study included 211 laboratory-confirmed cases suffering from a mild form of the disease and completing their isolation period at a non-hospital center in the United Arab Emirates. Demographic and clinical information was collected by standardized questionnaire and from the medical records of the patient. Of the 211 participants, 25% tested negative in both sample types at the time of this study and 53% of the remaining patients had detectable viral RNA in their stools. A positive fecal viral test was associated with male gender, diarrhea as a symptom, and hospitalization during infection. A positive correlation was also observed between a delayed onset of symptoms and a positive stool test. Viral load in stools positively correlated with, being overweight, exercising, taking antibiotics in the last 3 months and blood type O. The viral load in nasopharyngeal swabs, on the other hand, was higher for blood type A, and rhesus positive (Rh factor). Regression analysis showed no correlation between the viral loads measured in stool and nasopharyngeal samples in any given patient. The results of this work highlight the factors associated with a higher viral count in each sample. It also shows the importance of stool sample analysis for the follow-up and diagnosis of recovering COVID-19 patients.

Antimicrobial prophylaxis and the rate of blood stream infections and Clostridioides difficile in pediatric stem cell transplantation: A single-center retrospective study.

The use of prophylactic antibiotics in the pre-engraftment period to minimize the risk of bacteremia is debatable given concerns of Clostridioides difficile (C.diff), antibiotics resistance, and disruption of gut microbiota. We retrospectively reviewed the rate and characteristics of bacteremia and C.diff infections within the first 100 days post-HSCT in all pediatric patients who received routine antibacterial prophylaxis during HSCT from 2015 to 2018. C.diff infection was defined by the presence of three or more unformed stools in 24h and positive stool test for C.diff or its toxins. One hundred and thirty-five (100 allogeneic and 35 autologous) transplants in 123 patients were eligible for analysis. Median age at transplant was 7.1 (range 0.2-13.7), 67 (55%) were women, and diagnosis was malignant condition in 68 patients. Median time to neutrophil engraftment was 18 days (13-23). Cefepime or piperacillin-tazobactam prophylaxis was used in 105 (78%) and 28 (21%) of patients, respectively. Only five (3%) patients had bacteremia during the pre-engraftment period, and 13 (11%) patients developed bacteremia postengraftment. Septic shock was present in only one patient pre-engraftment and was due to gram-negative bacteria. All patients who developed bacteremia received MAC. Thirteen patients (10%) of patients fulfilled C.diff infection definition. There was no mortality related to bacterial infections among our patients. The use of antibiotic prophylaxis was associated with low rate of bacteremia in the pre-engraftment period and a 10% risk of C.diff infections. More studies are needed to better evaluate the efficacy of antibiotic prophylaxis in HSCT patients.

Participants' experiences of the management of screen-detected complex polyps within a structured bowel cancer screening programme.

The Bowel Screening Wales complex polyp removal service was introduced to address variations in surgery rates for screen-detected complex benign colorectal polyps, to improve the quality of the screening service and to make management of these polyps more equitable across Wales. Little is known about patient experiences and the potential impact on quality of life when undergoing complex polyp removal. This study is part of a wider research programme evaluating the decision-making, pathways and outcomes from complex polyp removal. This study aimed to understand experiences of having a complex polyp removed and how this may influence quality of life. Semi-structured telephone interviews were conducted, and a thematic approach was used for data analysis. All participants had a complex polyp removed after a positive stool test and review by Bowel Screening Wales' Network Multi-Disciplinary Team. Twenty-one participants were interviewed. Most participants had their complex polyps removed endoscopically and reported no or minor problems or negative outcomes following their procedure. For a small minority, worse problems (e.g., pain, bowel dysfunction) and negative outcomes (e.g., cancer) followed their procedures. Most participants felt supported and reassured throughout their procedures. Any physical and emotional changes to quality of life were mainly linked to procedure outcomes. Experiences of complex polyp removal were generally positive, with minimal changes in quality of life. While most people had a positive experience of having a complex polyp removed, support initiatives, such as counselling or signposting to coping strategies, may be helpful to reduce any potential negative effects of procedures on quality of life. Four patient and public involvement partners provided feedback on participant materials.

Colonoscopy Findings in FIT+ and mt-sDNA+ Patients versus in Colonoscopy-only Patients: New Hampshire Colonoscopy Registry Data.

Few studies compare fecal immunochemical test (FIT) and multi-target stool DNA (mt-sDNA) outcomes in practice. We compared colonoscopy yield following FIT+ or mt-sDNA+ tests to colonoscopies without preceding stool tests in the comprehensive population-based New Hampshire Colonoscopy Registry (NHCR). Outcomes were any neoplasia and an ordered outcome: adenocarcinoma, advanced neoplasia (adenoma/serrated polyp ≥ 1 cm/villous/high-grade dysplasia), nonadvanced neoplasia, or normal. Our total sample included 306 mt-sDNA+ (average age ± SD 67.0 ± 7.9), 276 FIT+ (66.6 ± 8.7), and 50,990 colonoscopy-only patients (61.8 ± 8.1). Among average-risk patients (N = 240 mt-sDNA+, N = 194 FIT+, N = 26,221 colonoscopy only), mt-sDNA+ patients had a higher risk for any neoplasia (67.1%) compared with FIT+ (54.6%, P = 0.00098) or colonoscopy (40.8%, P < 0.0001). Severity of findings and histology subtypes differed across the three groups (P < 0.0001 for both), with a higher yield of advanced findings in mt-sDNA+ patients. In particular, clinically relevant serrated polyps (hyperplastic polyps ≥10 mm/traditional serrated adenomas/sessile serrated polyps) were detected at a higher frequency in mt-sDNA+ patients as compared with FIT+ or colonoscopy-only patients. Even after adjustment, patients with positive mt-sDNA [OR = 2.82; 95% confidence interval (CI), 2.00-4.02] or FIT+ tests (OR = 1.67; 95% CI, 1.19-2.36) were more likely to have histologically more advanced findings than colonoscopy alone. At follow-up colonoscopy, mt-sDNA+ tests were more likely to predict neoplasia than FIT+, largely due to increased detection of serrated polyps. Prevention Relevance: Colorectal cancer screening options include colonoscopy and stool-based tests, including the fecal immunochemical test (FIT) and the multi-target stool DNA (mt-sDNA) test which, if positive, must be followed by a colonoscopy. Assessing "real-world" outcomes of colonoscopies following positive stool tests can inform their clinical use. See related Spotlight, p. 417.

Impact of the Sessile Serrated Polyp Pathway on Predicted Colorectal Cancer Outcomes.

Approximately 20%-30% of colorectal cancers (CRCs) arise from the serrated polyp pathway. CRC screening options have differential sensitivity to detect sessile serrated polyps (SSPs). We used the Colorectal Cancer and Adenoma Incidence and Mortality Microsimulation Model (CRC-AIM) to assess how the detection of SSPs impacts predicted life years gained (LYG), CRC incidence, and CRC mortality with multitarget stool DNA (mt-sDNA) or fecal immunochemical test (FIT) screening. A simulated cohort of average-risk US individuals underwent triennial mt-sDNA or annual FIT screening between ages 45-75 years. SSP-attributed CRCs were modeled at 0% (base case), 14.3%, 20%, and 30%, in combination with 4 adherence & attendance scenarios: S1: 100% stool-screening adherence/100% follow-up colonoscopy attendance after a positive stool test; S2: reported stool-screening adherence (mt-sDNA= 71%; FIT= 43%)/100% follow-up colonoscopy attendance; S3: reported stool-screening adherence/reported follow-up colonoscopy attendance (mt-sDNA= 72%; FIT= 47%); and S4: reported stool-screening adherence/72% follow-up colonoscopy attendance. Outcomes were per 1000 individuals. Sensitivity analyses used ranges of stool-screening adherence or follow-up attendance. At S1, S2, S3, and S4, LYG with FIT at the base case (0% SSP-attributed CRC) was 346.7, 279.3, 126.6, and 196.1, respectively, and with mt-sDNA was 324.6, 311.8, 215.8, and 215.8, respectively. Among the 4 adherence/attendance scenarios, modeling SSP-attributed CRCs decreased LYG by 4.9-20.9 with FIT and 2.0-5.1 with mt-sDNA. At S3 and 30% SSP-attributable CRCs, mt-sDNA had 95.1 more LYG, 21.5% greater CRC incidence reduction, and 22.2% greater CRC mortality reduction than FIT. Incorporating SSPs and real-world adherence into the CRC-AIM modeling analyses yielded more practice-relevant estimates of CRC screening outcomes and should be applied in future studies to afford more appropriate assessment of comparative effectiveness estimates between guideline-endorsed screening options.

766. Readmissions of Hospitalized Patients with Clostridioides difficile Infection (CDI) for Recurrent CDI Is Common

Abstract Background Hospital acquired infections (HAI) and hospital readmissions are of particular focus by Centers for Medicare and Medicaid Services. Clostridioides difficile infection (CDI) is an HAI notorious for causing recurrent illness and potentially resulting in re-hospitalizations. The purpose of our study was to identify the frequency of follow-up appointments in patients with CDI and determine the rate of re-hospitalization for recurrent CDI (rCDI). Methods This was a single-center, retrospective, chart review at a tertiary medical center. Through the electronic medical record, we queried all hospitalized patients with a positive stool test for C. difficile (GI panel PCR, FilmArray, Biofire, or C. difficile PCR, Xpert CD assay, Cepheid) with or without an ICD-10 code Enterocolitis due to C. difficile (A04.7, A04.71, A04.72) from January 2018 through April 2018. Demographic and clinical data at the time of diagnosis and up to 90 days after were collected from patient records. Results One-hundred and eighty-five patient episodes were evaluated. Of these, 147 (79.5%) were primary CDI, 13 (7.0%) were rCDI, and 25 (13.5%) were determined to be colonization. Twenty-two (11.9%) patients from the total cohort attended a follow-up appointment for CDI within 30 days, most often with a primary care provider or infectious disease physician. Twenty-three (12.4%) patients, 18 of whom were hospitalized for primary CDI episodes, developed a recurrent episode within 90 days of their initial CDI episode. Of these 23 patients with rCDI, 10 (43.5%) patients were re-hospitalized for their rCDI. Only 4 (17.4%) patients with rCDI had a follow-up appointment after their primary episode and among the 10 patients re-hospitalized for rCDI, only 2 (20.0%) patient had been seen for follow up for their previous CDI episode. Conclusion In our study, few patients had a follow-up appointment for CDI. Also, more than one third of the patients who had rCDI had to be re-hospitalized for the recurrent episode. Our study highlights a concern that the majority of patients re-hospitalized with rCDI did not have a follow-up appointment within 30 days of their initial diagnosis. Further study is necessary to determine if a dedicated follow-up appointment for CDI would result in decreased re-hospitalizations associated with rCDI. Disclosures Stuart Johnson, MD, Acurx Pharmaceuticals (Advisor or Review Panel member)Bio-K+ (Advisor or Review Panel member)Ferring Pharmaceutical (Advisor or Review Panel member)

EP.TU.701Colon Capsule Endoscopy versus Computed Tomographic Colonography for identifying Colorectal Cancer and Polyps: a systemic review and meta-analysis

AimEarly diagnosis and treatment of Colorectal Cancer can improve outcomes. Polypectomy with colonoscopy has failure and incompletion rates with risk of aerosol-generation. Computed Tomographic Colonography, second investigation, is limited by radiation exposure and aerosol generation. Colon Capsule endoscopy is a novel technique without gas insufflation, therefore avoiding the discomfort and aerosol-generation.Our aim is to compare the yield of the CCE with CTC in CRC and polyps in patients with positive stool tests or diagnosed colorectal lesions.MethodsReview followed PRISMA standards. Electronic database (EMBASE, MEDLINE, PubMed, CINAHL) searched for RCTs and Observational studies. MedCalc Statistical Software used for the synthesis of results. Primary (Per-Lesion and Per-Patient sensitivity analysis) and secondary (Other lesion and completion rate sensitivity analysis) outcomes measured using a random-effect model.ResultsWe found one RCT and three observational studies. Per-Lesion Sensitivity Analysis of CCE versus CTC showed overall effect of 1.903 (0.990- 1.937), p-value-0.057. Per-Patient Sensitivity Analysis of showed overall effect of 1.928 (0.995-1.892), p-value-0.054. Other lesions Sensitivity Analysis showed overall effect of 0.810 (0.121-161.995), p-value-0.418. Completion Rate Sensitivity Analysis showed overall effect of -0.419 (0.526-1.516), p-value-0.676.ConclusionCCE had a better detection rate for colorectal cancer and polyp than the CTC, but this was not statistically significant. Therefore, this study failed to prove CCE's superiority over CTC. A careful decision can be made in current COVID-19 pandemic since its advantage of zero aerosolisation. Researchers should focus on innovation in techniques and simultaneous high-quality studies to evaluate them.