P031 DETECTION OF BACTERIAL ENTERIC INFECTION IMPACTS MANAGEMENT OF OUTPATIENTS WITH FLARES OF INFLAMMATORY BOWEL DISEASE. (7th February 2019)

• Record Type: Journal Article
• Authors: Hong, Soonwook; Chang, Shannon; Hudesman, David; Axelrad, Jordan
• Is Part Of: Inflammatory bowel diseases. Volume 25(2019)Supplement 1
• Page Start: S15
• Page End: S15
• Publication Date: 2019-02-07
• Subjects: Inflammatory bowel diseases -- Periodicals; Colitis, Ulcerative -- Periodicals; Crohn Disease -- Periodicals; Inflammatory Bowel Diseases -- Periodicals; 616.344
• DOI: 10.1093/ibd/izy393.036
• Languages: English
• ISSNs: 1078-0998

Abstract

Abstract: Background: Multiplex polymerase chain reaction based stool assays for gastrointestinal pathogens (GI PCR) allow for the timely and accurate detection of enteric infections that were poorly characterized by conventional means such as stool culture. Despite the increasing availability of these molecular diagnostic tools, few studies have evaluated their use in outpatients with inflammatory bowel disease (IBD). Our objective was to evaluate the burden and impact of enteric infections detected by multiplex PCR stool testing in outpatients presenting with flares of IBD. Methods: We performed a cross-sectional study of 40 outpatients with IBD who underwent a GI PCR from September 2015 to August 2018 at a single health system. The primary outcome was the detection of an infection. Secondary outcomes included the presence of specific symptoms at presentation, biomarkers of inflammation, IBD medication exposures, directed antimicrobial therapies, utilization of endoscopy and radiology within 30 days of the flare, and IBD outcomes within 90 days of the flare. Results: We identified 19 patients with Crohn's disease (CD) and 21 with ulcerative colitis (UC). 11/40 (27.5%) had a bacterial enteric infection including 3 positive for enteropathogenic E. coli (EPEC), 2 for enterotoxigenic E. coli (ETEC), 2 for Campylobacter jejuni, 2 for Clostridium difficile, 1 for Yersinia enterocolitica, and 1 for both C. jejuni and ETEC. Compared to patients without an infection, patients with an infection were younger on presentation (mean age 37 vs 46 years, p=0.035), more likely to receive directed antibiotics (82% vs 10%, p<0.001), more likely to undergo endoscopy (55% vs 21%, p=0.037), and less likely to undergo abdominal radiography (0 vs 31%, p=0.036). There were no differences in race, gender, IBD subtype, travel history, symptoms, CRP, ESR, or fecal calprotectin levels on presentation between patients with and without a bacterial enteric infection. There were no differences in 90-day outcomes including subsequent ER visits, hospitalizations, or surgeries between patients with and without a bacterial enteric infection. Conclusion: The identification of a bacterial enteric infection in outpatients with flares of IBD was common, increasing exposure to directed antimicrobials and endoscopy while decreasing exposure to radiography. The increased utilization of endoscopy may reflect provider preference for further delineating the contribution of bacterial infection to a patient's presentation. Further study is required to identify the optimal management of patients with flares of IBD complicated by enteric infection.