P1491 - Evaluating Current Practices in Identifying CMV Infection in Patients Hospitalized With Inflammatory Bowel Disease Flares

Nivita Sharma, MD¹, Alice Parish, ², Donna Niedzwiecki, PhD², Talisha Ramchal, MD¹, Cecelia Zhang, MD^1
1Duke University Hospital, Durham, NC; ²Duke University, Durham, NC

Introduction: Cytomegalovirus (CMV) colitis can be seen in patients with ulcerative colitis (UC) or Crohn’s disease (CD) flares due to severe chronicity of inflammation and the use of immunosuppressive therapies. In patients who do not show initial improvement with IV steroids, it is recommended that endoscopic evaluation is performed within 72 hours of admission to evaluate disease severity and obtain biopsies for CMV colitis prior to pursuing biologic rescue therapy in acute severe ulcerative colitis. Immunohistochemistry (IHC) staining is the gold standard for diagnosing CMV colitis, but testing rapidity may depend on specimen marking by the gastroenterologist (i.e., routine vs STAT). Currently, the turnaround time (TAT) for biopsy samples to rule out CMV colitis is unknown.

Methods: We conducted a retrospective, observational, single-center, cohort study of patients ≥18 years admitted for complications related to UC or CD from January 1, 2022 to December 31, 2022 at our institution. All admissions that met pre-determined primary and secondary ICD-10 codes were reviewed and only hospitalizations for inflammatory bowel disease (IBD) flares were included. Descriptive statistics and univariate analyses using t-tests, Spearman correlations, and Wilcoxon rank-sum tests were performed.

Results: Of the 35 patients who were admitted with IBD flares, 20 (57.1%) had CD, 14 (40.0%) had UC, and 1 (2.9%) had indeterminate colitis. A total of 27 (77.1%) patients received IV steroids and 18 (51.4%) patients underwent endoscopic evaluation with colonoscopy or flexible sigmoidoscopy. Among the 18 patients who underwent endoscopic evaluation, 12 (66.7%) patients underwent biopsies for CMV rule out. Of the 12 CMV pathologies, 8 (66.7%) were ordered as routine and 4 (33.3%) ordered as STAT. There was no significant difference in the TAT for CMV pathology results in specimens that were sent routine (median time 82.6 hours) vs STAT (median time 82.7 hours) (p=0.88).

Discussion: This study highlights that there are variabilities in specimen marking (routine vs STAT) for biopsies that are sent for CMV IHC staining. We expected pathology results for specimens marked STAT to return sooner; however, there was no difference in the TAT suggesting that specimen marking does not influence the TAT. Further studies are needed to evaluate factors that influence TAT for CMV IHC staining in patients hospitalized with IBD flares.


Disclosures:


Nivita Sharma, MD¹, Alice Parish, ², Donna Niedzwiecki, PhD², Talisha Ramchal, MD¹, Cecelia Zhang, MD¹. P1491 - Evaluating Current Practices in Identifying CMV Infection in Patients Hospitalized With Inflammatory Bowel Disease Flares, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.