P4408 - Recurrent Clostridioides difficile Infection in Crohn's Disease: A Case Series

Landen Shane Burstiner, DO, MSc¹, Nadim A. Qadir, DO², Gerardo Diaz Garcia, DO¹, Anvit D. Reddy, DO¹, Oshin Rai, DO¹, Lauren N.. Stemboroski, DO¹, Marianny Sulbaran Nava, MD, PhD, MS^1
1University of Florida College of Medicine, Jacksonville, FL; ²University of Florida College of Medicine, Windermere, FL

Introduction: Clostridioides difficile infection (CDI), presents a challenge in Crohn’s Disease in terms of diagnosis, treatment, and prevention of recurrence. Current guidelines recommend treating recurrent CDI in inflammatory bowel disease (IBD) with a taper or pulse dose of oral vancomycin or fidaxomicin, but not metronidazole. Per guidelines, fecal microbiota transplant can be considered after the second recurrence and bexlotoxumab can be considered as a recurrence prevention strategy. We present a case series of 4 female patients with Crohn’s Disease, who were diagnosed with recurrent CDI and had a variety of different treatment regimens and outcomes.

Case Description/Methods: Patient #1 suffered two episodes of CDI a year apart, both managed with oral vancomycin. She underwent total colectomy at age 65 and passed away at 67 while hospitalized for hyponatremia secondary to CDI.

Patient #2 was diagnosed with ileocolonic Crohn’s and her first CDI at age 21, followed by two more occurrences over the next year. When attempting a 7-week taper of vancomycin she was readmitted with CDI. She underwent fecal microbiota transplant (FMT) with no further CDI over the next 5 years.

Patient #3 presented at age 51 with CDI treated with fidaxomicin. She had 3 further episodes and underwent colonoscopy which showed pancolitis and was diagnosed with Crohn’s Disease. After two more CDIs the patient underwent FMT, which worsened her diarrhea. Ultimately, after 3 years and 7 hospitalizations for CDI, total colectomy with end ileostomy was performed.

Patient #4 was diagnosed with early-onset ileocolonic Crohn’s Disease at age 8, undergoing colectomy at that time. At age 16, she developed CDI and was readmitted every single time she tried to wean off oral vancomycin. She has been continued on prophylactic vancomycin 500 mg twice per day for the last 7 years and has been followed in the gastroenterology clinic without CDI recurrence.

Discussion: Our case series illustrates the complexities and variance in treatment of recurrent CDI in patients with Crohn’s Disease. The majority of clinical trials on CDI treatments exclude patients with IBD, which leaves treatment guidance relatively vague. The four cases above demonstrate how treatment is often customized based on the individual patient, and underline the need for clinical trials on recurrent CDI in the IBD population in order to optimize therapy.


Disclosures:


Landen Shane Burstiner, DO, MSc¹, Nadim A. Qadir, DO², Gerardo Diaz Garcia, DO¹, Anvit D. Reddy, DO¹, Oshin Rai, DO¹, Lauren N.. Stemboroski, DO¹, Marianny Sulbaran Nava, MD, PhD, MS¹. P4408 - Recurrent <i>Clostridioides difficile</i> Infection in Crohn's Disease: A Case Series, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.