P0229 - Impact of Patient and Provider Variability on Compliance With C. difficile Testing for IBD Flares

Danielle Garfunkel, MD¹, Daniel Alvarez, MD², George G.. Papadopoulos, MD³, Hamza Sadhra, MD³, Melissa Fazzari, PhD, MS⁴, Ruby Greywoode, MD, MS⁴, Thomas Ullman, MD^4
1Montefiore Medical Center, Scarsdale, NY; ²Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY; ³Montefiore Medical Center, Bronx, NY; ⁴Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY

Introduction: Over three decades, the incidence of Clostridioides difficile (C-diff) in inflammatory bowel disease (IBD) patients has risen dramatically. Though guidelines advise testing all patients with IBD flares for C-diff, there is little data on compliance with this recommendation. This study investigates C-diff testing compliance rates, factors affecting testing and impact of testing in IBD flares on length of stay (LOS) and readmissions.

Methods: We conducted a retrospective cohort study at a tertiary academic medical center of adults admitted for IBD flares with documented diarrhea from 3/2019-3/2021. We excluded patients who left the emergency department (ED) against medical advice. Demographic and clinical data were gathered by chart review. Primary outcome was C-diff testing rates. Secondary outcomes included time to testing. Admissions from 3/2019-3/2020 were compared to 3/2020-3/2021 to evaluate the COVID pandemic effect. We employed chi-square and Wilcoxon Mann-Whitney tests to examine associations and multivariate Poisson regression model to adjust for confounders.

Results: Of 802 admissions, 195 (24%) were included. The mean age was 38 years with 55% males, 55% of Hispanic ethnicity and 53% with ulcerative colitis (Table 1). 83% of cases were tested for C-diff with a 7% positivity rate. 71% were sent in the inpatient setting rather than the ED and 66% were sent before day 2 of hospitalization. Of those not tested, 30% had resolved diarrhea and 12% were canceled by lab (Fig. 1). Factors associated with increased testing included gastroenterology consultation (85% vs 63%, p=0.02), higher heart rate (98 vs 87, p=0.02), and positive SIRS criteria (91% vs 79%, p=0.04). During the COVID pandemic, ED testing rates declined (38% vs 18%, p=0.01). After adjusting for confounders, expected LOS was 54% longer among those tested than not tested (p< 0.0001). Those tested tended to have longer time to readmission (104d vs 45d, p=0.19).

Discussion: At our hospital, C-diff testing rates for IBD flares were relatively high, though most tests were delayed until inpatient admission. Gastroenterology consultation and patient illness severity led to increased testing. Patients tested for C-diff had longer LOS likely due to increased testing during lengthier admissions; those not tested had shorter time to readmission perhaps indicating broader barriers to care. This highlights the pivotal role of GI consultants and the need to promote non-GI provider awareness for C-diff testing to improve IBD patient care.



Disclosures:


Danielle Garfunkel, MD¹, Daniel Alvarez, MD², George G.. Papadopoulos, MD³, Hamza Sadhra, MD³, Melissa Fazzari, PhD, MS⁴, Ruby Greywoode, MD, MS⁴, Thomas Ullman, MD⁴. P0229 - Impact of Patient and Provider Variability on Compliance With C. difficile Testing for IBD Flares, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.