P1586 - Association of Enteric Infections and Disease Activity in Inflammatory Bowel Disease

Christopher Kim, MD¹, Manuel A. Garza, MD¹, Vamsi Maturi, BS², Medha Narwankar, BS², Adam Saleh, BS², Kerri Glassner, DO¹, Caroline Perry, BS¹, Bincy P. Abraham, MD, MS^3
1Houston Methodist Hospital, Houston, TX; ²Texas A&M Health Science Center College of Medicine, Houston, TX; ³Houston Methodist-Weill Cornell Medical College, Houston, TX

Introduction: Patients with IBD often present with abdominal pain and diarrhea. However, distinguishing between active IBD, acute enteric infection, or the coexistence of both, can be difficult. It is unknown whether enteric infection may be a manifestation of active disease in patients with IBD, and only a few studies have evaluated endoscopic findings in symptomatic IBD patients with a positive stool PCR. Our aim was to assess whether enteric infections in IBD patients are associated with disease activity.

Methods: A retrospective observational cohort analysis of IBD patients with Crohn’s disease, ulcerative colitis or indeterminate colitis seen at HMH IBD Center from 2015 to 2020 who had stool PCR testing for diarrhea was performed. Data was collected on demographics including age, sex, disease subtype, disease location and endoscopic findings within 3 months of stool PCR. Patients without endoscopic findings within 3 months were excluded. Endoscopic scoring was converted to remission, mild, moderate or severe based on the Mayo endoscopic score or Rutgeert’s score and/or Crohn’s Disease Simple Endoscopic score.

Results: There were 193 patients who had at least one stool PCR test for a total of 258 stool PCRs. Among these, an enteric infection was identified in 95(49.22%) of patients and 138(53.49%) of the PCR tests. Patients with an enteric infection were significantly less likely to have CD, 62 (44.93%) compared to 77 (64.1%) those without infection, (p=0.0077) (Table 1). There was a significant difference in endoscopic findings at three months with and without enteric infection (p=.017). Patients with disease located in either colon or small bowel alone were significantly associated with a positive stool PCR. An elevated lactoferrin was significantly associated with a positive stool PCR (p =0.02), but was not significant for an elevated fecal calprotectin. The most common infection identified was Clostridioides difficile in 65 (46.43%) followed by Enteropathogenic Escherichia Coli 19 (13.57%) (Table 2).

Discussion: IBD patients in our study population showed that UC more than CD, those with colonic or small bowel disease alone, and having higher endoscopic severity within 3 months of testing, were more likely to have stool PCR positive for enteric infection, most commonly Clostridioides difficile and Escherichia coli. Our study shows that achieving endoscopic remission especially in those with UC or colonic disease can reduce the likelihood of enteric infections in our IBD patients.

Variable		Positive stool PCR (n=138)	Negative stool PCR (n=120)	T-Test P-Value	Chi-square P-value
Sex	Female Male	87 (63.0%) 51 (37.0%)	70 (58.3%) 50 (41.7%)	0.303
Disease subtype	CD IC UC	62 (44.9%) 7 (5.1%) 69 (50%)	77 (64.2%) 5 (4.2%) 38 (31.7%)	0.0019 0.7316 0.0028	0.0077
Disease location	Both Colon Small bowel	44 (33.1%) 85 (63.9%) 4 (3.0%)	50 (42.4%) 55 (46.6%) 13 (11.0%)	0.1042 0.0111 0.0103	0.0047
3 Month Endoscopic findings	Remission Mild Moderate Severe	19 (23.2%) 18 (22.0%) 10 (10.2%) 35 (42.7%)	27 (35.5%) 16 (21.1%) 17 (22.4%) 16 (21.1%)	0.0680 0.9455 0.0706 0.0154	0.017
Lactoferrin		468.4 (+/- 532.7)	190.7 (+/- 332.5)	0.0248
Calprotectin		658.3 (+/-587.1)	1004.6 (+/- 720.7)	0.2395

Table: Characteristics and endoscopic findings in IBD patients with and without enteric infections identified on stool PCR testing. Abbreviations: standard deviation (std), Crohn’s disease (CD), Ulcerative colitis (UC), indeterminate colitis (IC), polymerase chain reaction (PCR).


Disclosures:
Christopher Kim indicated no relevant financial relationships.
Manuel Garza indicated no relevant financial relationships.
Vamsi Maturi indicated no relevant financial relationships.
Medha Narwankar indicated no relevant financial relationships.
Adam Saleh indicated no relevant financial relationships.
Kerri Glassner indicated no relevant financial relationships.
Caroline Perry indicated no relevant financial relationships.
Bincy Abraham: Abbvie – Consultant, Speaker's Bureau. BMS – Consultant, Speaker's Bureau. Ferring – Consultant. Janssen – Consultant, Speaker's Bureau. Medtronic – Consultant. Pfizer – Consultant, Speaker's Bureau. Samsung – Consultant. Takeda – Consultant, Grant/Research Support.


Christopher Kim, MD¹, Manuel A. Garza, MD¹, Vamsi Maturi, BS², Medha Narwankar, BS², Adam Saleh, BS², Kerri Glassner, DO¹, Caroline Perry, BS¹, Bincy P. Abraham, MD, MS³. P1586 - Association of Enteric Infections and Disease Activity in Inflammatory Bowel Disease, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.