P845 Impact of Clostridium difficile infection in patients admitted with ulcerative colitis

B. Gros Alcalde, P. Soto Escribano, E. Iglesias-Flores, S. Marín Pedrosa, V. García-Sánchez, J.M. Benítez

Reina Sofía University Hospital, Department of Gastroenterology, Córdoba, Spain

Background

Clostridium diffile (CD) infection it is becoming increasingly more prevalent in general population and especially in patients with inflammatory bowel diseases (IBD). Patients with ulcerative colitis (UC) with CD infection during a flare can present greater morbidity and mortality. The objectives of the study were (a) to evaluate the proportion of CD infection in patients admitted with UC; (b) to compare the rates of colectomy in UC admitted with and without CD infection; (c) to analyse the association between the infection and worse results according to readmissions, need of treatment intensification and hospital stay; and (d) to describe predictive factors associated with worse evolution in patients with CD infections.

Methods

Cases and controls retrospective study. We included patients admitted due to a flare of UC in our hospital from 2000 to 2018. Variables related to hospital stay, adverse events, need of colectomy in the first year and mortality were collected. We analysed the data with SPSS using chi-square test, Kruskal–Wallis and multivariant analysis to identify factors of bad evolution.

Results

We analysed 235 admitted patients with UC flare. 62.1% male, mean age 43.6 years old (SD 12). Seventy-two per cent presented extensive colitis and 22% left coliits. 7.7% had perianal disease and 8.7% extraintestinal manifestations. Endoscopic activity was 75.8% Mayo Index 3 and 23% Mayo Index 2. 15.9% of the patients had complications during their hospitalisation related to their disease: 37.8% had toxic megacolon, 11% perforation and 11.2% of the total needed surgery during the hospitalisation. Twenty-eight patients (12.2%) had CD infection, among them 23.5% suffered recurrence infection of CD. This infection was statistically significant related to a higher rate of readmission (48.1% vs. 23%, p = 0.007) and higher rates of colectomy during the first year from the admission (13% vs. 2.9%, p = 0.05). We did not find differences among both groups of patients in terms of complications of their IBD, neither need of treatment intensification, nor mortality. Predictive factors of bad evolution were not identify with multivariant analysis.

Conclusion

CD infection is prevalent in UC admitted patients, with high rates of recurrence, this infection is related with higher rates of readmission and bigger need of colectomy during the first year.