S138 Incidence and Outcomes of C. difficile Infection Following Colon Ischemia

Introduction: Colon Ischemia (CI) is the most common ischemic injury to the gastrointestinal tract. Clostridioides difficile infection (CDI) is the most common healthcare-associated infection. There is limited knowledge of the risk of CDI after CI. Our hypothesis is that CI patients who develop CDI have worse outcomes compared with CI patients who don’t develop CDI. (Figure) Methods: We conducted a multicenter retrospective cohort study of patients admitted with biopsy-proven CI to Yale-New Haven Health Hospital, Montefiore Medical Center, Weiler Medical Center, and SUNY-Upstate Medical Center from 2005 to 2019. For each patient, we recorded numerous factors including the ACG severity scoring system. Patients who had CDI within 3 months following CI (CI+CDI) were compared to patients who did not develop CDI (CI-CDI). Primary outcome was to measure frequency of occurrence CDI in the CI population, secondary outcomes included comparing 30-day and 90-day colectomy, recurrent CI, readmission, and mortality from the time of diagnosis of CI, and segmental involvement of CI+CDI to CI-CDI. Multivariate logistic regression was performed after adjusting for the age, gender, race, Charlson Comorbidity Index (CCI) and the severity of CI. Results: 906 patients met inclusion criteria with Bx proven CI. 3.2% developed CDI between 2005 and 2019 Figure. There were no differences between CI+CDI (n=29) and CI-CDI groups (n=877) with regards to gender, BMI, medical co-morbidities, or severity. CI+CDI patients had more isolated right-colon involvement (38.8% vs 16.5%, p=0.013), 30-day readmission (51.7% vs 9.3%, p< 0.001), 90-day readmission (65.5% vs 18.1%, p< 0.001), 30-day reoccurrence of CI (17.2% vs 1.6%, p< 0.001), 90-day reoccurrence of CI (24.1% vs 3.6%, p< 0.001) and 90-day mortality (17.8% vs 7.5%, p=0.047) than CI-CDI. When adjusting for age, gender, race, CCI and severity, patients with CI+CDI were at higher risk for 30-day readmission [OR 10.62 (95% CI: 4.2-26.3), p< 0.001], 90-day readmission [OR 10.45 (95% CI: 4.0-26.8), p< 0.001], 30- day reoccurrence CI [OR 7.3 (95% CI: 1.9 -27.3), p=0.003] and 90-day reoccurrence CI [OR 5.7 (95% CI: 1.8-17.2), p=0.003] compared with CI-CDI group (Table). Conclusion: CI patients who developed CDI had higher rates of CI recurrence, more frequent readmission, and were more likely to have isolated right colon involvement than CI-CDI. When a patient with a recent history of CI is diagnosed with CDI, they might benefit from more aggressive therapy to try to improve these outcomes.Figure 1.: Annual incidence of CI+CDI. Abbreviations: BMI, Body mass index; CI, colon Ischemia; ICU, Intensive Care Unit Table 1. - Baseline demographics, clinical characteristics, and outcomes of pts in Post CI+CDI and Post CI-CDI groups Parameter CI+CDIn=29 CI-CDIn=877 p value Parameter CI+CDIn=29 CI-CDIn=877 p value Demographics Bowel involvement CI Age (median, (IQR)) 78 (71-83) 70 (61-79) 0.009 Small bowel involvement, n (%) 0 (0.00) 40 (7.60) 0.212 BMI (median, (IQR)) 28.4 (22.34-31.15) 27.23 (23.58-31.56) 0.926 Pancolitis, n (%) 1 (4.00) 38 (5.18) 0.792 Females, n (%) 24 (82.76) 625 (71.27) 0.177 Any right colon involvement, n (%) 8 (44.44) 157 (25.49) 0.071 Medical Comorbidities Diabetes Mellitus, n (%) 10 (34.48) 263 (29.99) 0.604 Right colon only, n (%) 7 (38.89) 103 (16.59) 0.013 Hypertension, n (%) 21 (72.41) 658 (75.03) 0.749 CI severity Coronary Artery Disease, n (%) 8 (27.59) 261 (29.86) 0.792 Mild/Moderate CI, n (%) 10 (34.48) 441 (50.69) 0.086 Atrial Fibrillation, n (%) 8 (28.57) 129 (15.60) 0.066 Severe CI, n (%) 19 (65.52) 429 (49.31) Peripheral Vascular Disease, n (%) 4 (13.79) 73 (8.37) 0.304 Charlson co-morbidity Index, median (IQR) 5 (4-8) 5 (3-7) 0.057 Cerebral Vascular Disease, n (%) 5 (17.24) 92 (10.50) 0.248 ICU requirement, n (%) 6 (20.69) 213 (24.77) 0.616 Constipation, n (%) 8 (28.57) 224 (25.66) 0.729 Treatment Pulmonary diseases, n (%) 5 (17.24) 185 (21.14) 0.612 Treatment with Antibiotics, n (%) 22 (75.86) 589 (68.73) 0.414 Outcomes Length of stay (mean, (SD)) 3 (1-10) 3 (1-7) 0.751 Adjusted Odds Ratio* (CI+CDI vs CI-CDI) 95% Confidence Interval p value 30-day readmission, n (%) 15 (51.7) 82 (9.3) < 0.001 10.62 [4.28 - 26.37] < 0.001 90-day readmission, n (%) 19 (65.5) 159 (18.13) < 0.001 10.45 [4.06 - 26.88] < 0.001 30-day recurrence of CI, n (%) 5 (17.24) 14 (1.6) < 0.001 7.30 [1.94 - 27.37] 0.003 90-day recurrence of CI, n (%) 7 (24.14) 32 (3.65) < 0.001 5.70 [1.88 - 17.29] 0.002 30-day colectomy, n (%) 4 (14.81) 108 (12.36) 0.703 1.78 [0.46 - 6.91] 0.408 90-day colectomy, n (%) 4 (14.81) 101 (11.57) 0.605 2.24 [0.57 - 8.85] 0.251 30-day mortality, n (%) 3 (10.71) 47 (5.39) 0.226 1.09 [0.13 - 9.07] 0.933 90-day mortality, n (%) 5 (17.86) 66 (7.59) 0.047 2.15 [0.56 - 8.31] 0.267 *Multivariate logistic regression for the outcomes of CI+CDI compared to CI-CDI (reference group). Analysis adjusted for age, gender, race, Charlson co-morbidity index and CI severity.Abbreviations: BMI, Body mass index; CI, colon Ischemia; ICU, Intensive Care Unit.