CLINICAL CHARACTERISTICS AND OUTCOMES OF CLOSTRIDIUM DIFFICILE ENTERITIS VERSUS COLITIS AMONGST HOSPITALIZED PATIENTS: A RETROSPECTIVE CASE CONTROL STUDY
DDW ePoster Library. Hitawala A. 05/21/21; 319710; Fr560
Dr. Asif Hitawala
Dr. Asif Hitawala
Contributions Biography
Abstract

Number: Fr560
CLINICAL CHARACTERISTICS AND OUTCOMES OF CLOSTRIDIUM DIFFICILE ENTERITIS VERSUS COLITIS AMONGST HOSPITALIZED PATIENTS: A RETROSPECTIVE CASE CONTROL STUDY

Society: AGA
Track: Microbiome in Gastrointestinal and Liver Diseases
Category: Basic & Clinical Intestinal Disorders

Author(s): Asif A. Hitawala1, Ashraf Almomani1, Madhusudhan R. Sanaka21 Internal Medicine, Fairview Hospital, Cleveland, Ohio, United States; 2 Cleveland Clinic, Cleveland, Ohio, United States

Introduction
Clostridium difficile infection (CDI) is the most common cause of infectious diarrhea in the United States. It commonly affects the colon, and can cause mild to fulminant disease. Recently, there have been multiple reports of CDI of the small bowel, which is considered an important cause of high-output from ileostomy. However, there is limited data comparing clinical characteristics and outcomes of these patients to those with CDI of the colon. Hence, we performed a retrospective study to assess the same.

Methods
We performed a search on all patients admitted to the Cleveland Clinic hospitals from January 1st, 2008 to January 1st, 2020 with a diagnosis of CDI of the small bowel. Inclusion criteria were as follows: 1) Age ≥ 18 years; 2) Positive Clostridium difficile assay with stool sample obtained from the ileostomy; 3) Documentation of active CDI. We then acquired two age- and sex-matched hospitalized patients who had CDI of the colon for every patient with CDI of the small bowel. Clinical characteristics and outcomes were recorded. American College of Gastroenterology 2013 guidelines were used to describe severity of the disease. The data was analyzed using R software.

Results
A total of 36 cases of CDI of the small bowel were identified. Results are summarized in table 1. Median age was 62.5 years, with males and females affected equally. When compared with patients hospitalized with CDI of the colon, patients with CDI of the small bowel had more severe disease, antidiarrheal medication use on admission and Crohn's disease. Both groups were treated similarly with metronidazole and/or vancomycin (p >0.2), had similar duration of treatment (p= 0.851), length of stay (LOS) as well as death rate and CDI recurrence within 56 days. Admission to intensive care unit (ICU) was significantly associated with death (p= 0.038), even when adjusted for group (p=0.039). Similarly, opiate use was significantly associated with CDI recurrence. The presence of antibiotic use within past 30 days (p=0.019), concurrent antibiotic use for another infection (p=0.015), use of prokinetics prior to admission (p= 0.034) and ICU admission (p <0.001) were significantly associated with longer hospital LOS, even when adjusted for the group.

Conclusion
Amongst hospitalized patients, patients with CDI of the small bowel tend to have similar outcomes as compared to those with CDI of the colon. Crohn's disease seems to be more prevalent in the former, suggesting that patients with CDI of the small bowel and Crohn's disease may be more likely to be hospitalized. Since treatment with vancomycin and/or metronidazole was similar in both groups, this suggests that current treatment strategies are effective for CDI of the small bowel. Patients admitted to ICU tend to have worse outcomes, which is consistent with these patients being critically ill.

Number: Fr560
CLINICAL CHARACTERISTICS AND OUTCOMES OF CLOSTRIDIUM DIFFICILE ENTERITIS VERSUS COLITIS AMONGST HOSPITALIZED PATIENTS: A RETROSPECTIVE CASE CONTROL STUDY

Society: AGA
Track: Microbiome in Gastrointestinal and Liver Diseases
Category: Basic & Clinical Intestinal Disorders

Author(s): Asif A. Hitawala1, Ashraf Almomani1, Madhusudhan R. Sanaka21 Internal Medicine, Fairview Hospital, Cleveland, Ohio, United States; 2 Cleveland Clinic, Cleveland, Ohio, United States

Introduction
Clostridium difficile infection (CDI) is the most common cause of infectious diarrhea in the United States. It commonly affects the colon, and can cause mild to fulminant disease. Recently, there have been multiple reports of CDI of the small bowel, which is considered an important cause of high-output from ileostomy. However, there is limited data comparing clinical characteristics and outcomes of these patients to those with CDI of the colon. Hence, we performed a retrospective study to assess the same.

Methods
We performed a search on all patients admitted to the Cleveland Clinic hospitals from January 1st, 2008 to January 1st, 2020 with a diagnosis of CDI of the small bowel. Inclusion criteria were as follows: 1) Age ≥ 18 years; 2) Positive Clostridium difficile assay with stool sample obtained from the ileostomy; 3) Documentation of active CDI. We then acquired two age- and sex-matched hospitalized patients who had CDI of the colon for every patient with CDI of the small bowel. Clinical characteristics and outcomes were recorded. American College of Gastroenterology 2013 guidelines were used to describe severity of the disease. The data was analyzed using R software.

Results
A total of 36 cases of CDI of the small bowel were identified. Results are summarized in table 1. Median age was 62.5 years, with males and females affected equally. When compared with patients hospitalized with CDI of the colon, patients with CDI of the small bowel had more severe disease, antidiarrheal medication use on admission and Crohn's disease. Both groups were treated similarly with metronidazole and/or vancomycin (p >0.2), had similar duration of treatment (p= 0.851), length of stay (LOS) as well as death rate and CDI recurrence within 56 days. Admission to intensive care unit (ICU) was significantly associated with death (p= 0.038), even when adjusted for group (p=0.039). Similarly, opiate use was significantly associated with CDI recurrence. The presence of antibiotic use within past 30 days (p=0.019), concurrent antibiotic use for another infection (p=0.015), use of prokinetics prior to admission (p= 0.034) and ICU admission (p <0.001) were significantly associated with longer hospital LOS, even when adjusted for the group.

Conclusion
Amongst hospitalized patients, patients with CDI of the small bowel tend to have similar outcomes as compared to those with CDI of the colon. Crohn's disease seems to be more prevalent in the former, suggesting that patients with CDI of the small bowel and Crohn's disease may be more likely to be hospitalized. Since treatment with vancomycin and/or metronidazole was similar in both groups, this suggests that current treatment strategies are effective for CDI of the small bowel. Patients admitted to ICU tend to have worse outcomes, which is consistent with these patients being critically ill.

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