P4299 - Risk of Clostridium difficile Infections in Patients With Inflammatory Bowel Disease Taking Tumor Necrosis Factor Inhibitors: A 25-Year Multi-Center Analysis

Jordan Carty, MD¹, Mikaela Nikkola Jara-Tantoco, MD¹, Abiodun Idowu, MD², Simone Jarrett, MBBS¹, Michael L. Davis, DO^1
1Albert Einstein Medical Center, Philadelphia, PA; ²Jefferson Einstein Hospital, Philadelphia, PA

Introduction: Inflammatory bowel disease (IBD) has a bidirectional relationship with gut dysbiosis and the use of Tumor Necrosis Factor inhibitors (TNF-inhibitors) for IBD can lead to cytopenia. These factors might make IBD patients more susceptible to Clostridium difficile infections. However, there are limited studies on the rate of Clostridium difficile infections in patients with IBD who are taking TNF-inhibitors, and these studies are mainly from single centers. We aim to study the first-time incidence and recurrent rate of Clostridium difficile infection in IBD patients on TNF-inhibitors using a multicenter database.



Methods: We used the TriNetX database, a collaborative network comprising more than 100 healthcare organizations, to identify patients aged 18-75 years diagnosed with IBD (Ulcerative Colitis and Crohn’s disease) between January 1, 1998 and December 31, 2023. The patients were then stratified and propensity-matched to two cohorts based on their use of TNF-inhibitors and exposure to antibiotics. The risk ratio (RR) of Clostridium infection between the two groups was statistically computed at 95% confidence interval (CI) using R-software.

Results: Each cohort included 14,199 patients with an average age of 38.1 ± 15.5 years, consisting of 74.4% Caucasian and 50.5% female patients. Compared to IBD patients not taking TNF inhibitors, those TNF inhibitors have a 20% increased risk for first-time Clostridium difficile infection (RR: 1.20, 95% CI: 1.08-1.33, p< 0.001) and a 46% higher risk for recurrent Clostridium difficile infections (RR: 1.46, 95% CI: 1.18-1.81, p< 0.001). However, the rate of fecal microbiome transplantation (RR: 1.48, 95% CI: 0.89-2.45, p=0.125) was similar in both groups.

Discussion: Patients with IBD taking TNF inhibitors have an increased risk of Clostridium difficile infection. Further prospective cohort studies are needed to determine the clinical impact of our findings and to examine the underlying factors contributing to this occurrence.


Disclosures:


Jordan Carty, MD¹, Mikaela Nikkola Jara-Tantoco, MD¹, Abiodun Idowu, MD², Simone Jarrett, MBBS¹, Michael L. Davis, DO¹. P4299 - Risk of <i>Clostridium difficile</i> Infections in Patients With Inflammatory Bowel Disease Taking Tumor Necrosis Factor Inhibitors: A 25-Year Multi-Center Analysis, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.