Taiwo Ajose, MD1, Afolarin Ajose, MBBS2, Temidayo Abe, MD1, Phani Keerthi Surapaneni, MD1, Tolulope Abe, MD3, Temitope Tobun, MD3, Michael Flood, MD1; 1Morehouse School of Medicine, Atlanta, GA; 2Babcock University College of Medicine Nigeria, Atlanta, GA; 3All Saints University, Dominica, Roseau, Saint George, Dominica
Introduction: Clostridium difficile (CDIFF) is a pathogen that is known to cause antibiotics associated diarrhea, pseudomembranous colitis, and toxic megacolon. Over the last decade, there has been an exponential rise in the incidence and associated morbidity and mortality of CDIFF in the general population. An increased risk of CDIFF infection in immunocompromised patients has been well documented in literature postulated to be due to an impaired host immune response to toxins produced by CDIFF. Studies have also shown CDIFF to be the most commonly reported infectious diarrhea in patients with HIV in the united states. HIV patients are immunocompromised and have immunologic defects that may impair their antibody response to toxins produced by CDIFF and thus increasing their risk for CDIFF. However, it is unclear if the disease outcome is greater among patients with coexisting CDIFF and HIV compared to those with CDIFF alone. Methods: We reviewed records of 95,091 patients with the primary diagnosis of CDIFF from the National Inpatient sample 2009 to 2012, of which 48,060 (51%) had HIV. We compared baseline characteristics and outcomes in overall mortality, septic shock, colectomy, and colon perforation. Multivariate logistic regression analysis was then used to estimate the adjusted odds ratio (AOR) of outcomes among participants with coexisting CDIFF and HIV compared to those with CDIFF alone. Results: Patients with CDIFF/HIV were younger (mean age; 46 vs 69, p < 0.0001). Rates of septic shock (7.7% vs 7.3%; p= 0.09), colon perforation (0.2% vs 0.4%; p= 0.06) and mortality (8.1% vs 8.6%; p= 0.09) was significantly higher in patients with CDIFF/HIV. Rates of colectomy (0.5% vs 1.3%; p< 0.0001) was lower in patients without HIV. Table 1 displays the adjusted odds ratio for the study outcomes. Compared to patients with CDIFF alone, those with CDIFF and HIV had higher risk for mortality and septic shock. Discussion: Patients with CDIFF coexisting with HIV were at a higher risk for increased mortality and septic shock when compared with those with CDIFF alone. Further studies will look to evaluate and mitigate the impact of HIV on CDIFF in this patient population.
Disclosures: Taiwo Ajose indicated no relevant financial relationships. Afolarin Ajose indicated no relevant financial relationships. Temidayo Abe indicated no relevant financial relationships. Phani Keerthi Surapaneni indicated no relevant financial relationships. Tolulope Abe indicated no relevant financial relationships. Temitope Tobun indicated no relevant financial relationships. Michael Flood indicated no relevant financial relationships.