A268 TESTING AND TREATMENT OF CLOSTRIDIUM DIFFICILE INFECTION IN HOSPITALIZED INFLAMMATORY BOWEL DISEASE PATIENTS. (1st March 2018)

• Record Type: Journal Article
• Authors: Reinglas, J; Murthy, S
• Is Part Of: Journal of the Canadian Association of Gastroenterology. Volume 1(2018)Supplement 1
• Page Start: 465
• Page End: 466
• Publication Date: 2018-03-01
• Subjects: Gastroenterology -- Periodicals; 616.33005
• DOI: 10.1093/jcag/gwy008.269
• Languages: English
• ISSNs: 2515-2084

Abstract

Abstract: Background: Inflammatory bowel disease (IBD) is associated with an increased risk of contracting clostridium difficile infection (CDI) as well as an increased mortality risk in the setting of CDI. As such, early testing and treatment of CDI in IBD patients hospitalized for a disease flare is of paramount importance. Aims: To assess rates of C. difficile testing and treatment patterns among IBD patients admitted to The Ottawa Hospital for a disease flare. To characterize factors associated with appropriate testing of Clostridium Difficile infection (CDI) in this setting. Methods: A cross-sectional study was conducted in 200 consecutive patients admitted to our tertiary-care center for an IBD flare between January 1, 2011 and December 31, 2013. Outcomes assessed include the frequency and timing of CDI testing, type of CDI treatment and colectomy. Multivariable logistic regression was conducted to assess factors associated with CDI testing within 48 hours of admission. Results: Of 193 patients without known CDI at presentation, 162 patients (84%) were tested for CDI during admission and 153 patients (79%) were tested within 48 hours of presentation. Patients were more likely to be tested for CDI within 48 hours if they had ulcerative (UC) (vs. Crohn's disease (CD)) (88.7% vs 75.4%, p =0.048), if they were not on immunosuppressive (IS) therapy (vs. on IS therapy) at presentation (95.2% vs 76.5%, p=0.0075) and if they were admitted under a gastroenterologist (vs. non-gastroenterologist) (90.1% vs 74.1%, p < 0.0001). In multivariable analysis, UC diagnosis (aOR 2.4, 95% CI 1.1–5.1), admission under a gastroenterologist (aOR 3.1, 95% CI 1.4–6.8) and absence of corticosteroid therapy at presentation to hospital (aOR 3.2, 95% CI 1.5–6.8) were associated with higher rates of CDI testing within 48 hours of presentation. Of 20 patients who were positive for CDI, 16 patients (80%) received vancomycin +/- metronidazole as first line therapy. Fifteen patients (83%) with CDI diagnosed within 48 hours of admission received supplemental IS therapy for treatment of IBD. In-hospital colectomy was performed in 15% vs 6% of patients with and without CDI, respectively. Conclusions: A substantial proportion of IBD patients admitted to a tertiary-care center for a disease flare are not tested for CDI in a timely fashion. Patients who have UC, who are not on corticosteroids at presentation and who are admitted under a gastroenterologist are more likely to undergo CDI testing. Treatment of CDI in this setting is inconsistent and does not follow recommendations for first-line use of vancomycin in many patients. Better education of physicians who care for IBD patients is required to reduce these gaps in quality of care. Funding Agencies: None