S1785 Immunosuppressive Therapy Significantly Impacts Systemic Complications of First-Time Clostridioides difficile Infections Among Inflammatory Bowel Disease Inpatients: NIS Database Insights (2019-2021)

Introduction: IBD patients are susceptible to various forms of infectious colitis, including secondary to Clostridioides difficile infection (CDI). IBD patients increasingly exist in an immunocompromised state due to long-term use of glucocorticoids, immunomodulators, and biologic therapies. Evidence regarding the impact of immunosuppressants on CDI outcomes among IBD patients in the context of an initial infection is sparse. This study aims to investigate first-time CDI-related hospital outcomes of IBD patients classified as immunosuppressed vs those who are not. Methods: A retrospective observational analysis of the Nationwide Inpatient Sample (NIS) database from 2019-2021 was performed to identify adult hospitalizations involving first-time CDI among patients with IBD. Cases classified as recurrent were excluded. Patients were then separated into immunocompromised and immunocompetent subgroups. Previously validated International Classification of Diseases-10 -CM codes were used to identify appropriate patients. Key clinical outcomes were evaluated using univariate analyses followed by multivariate linear and logistic regression to control for potential confounding variables. Results: A total of 27,385 IBD patients with first-time CDI hospitalization were included in the study. Within this group, 7.14% of patients were deemed immunosuppressed. Immunosuppression was associated with lower odds of mortality, though the association did not achieve statistical significance (adjusted OR = 0.396, 95% CI = 0.147-1.06, P = 0.066). Immunosuppression did not influence length of stay (β = -0.058, 95% CI = -0.013-0.131, P = 0.112). Immunosuppressed patients had significantly reduced odds of septic shock, a major systemic complication, but increased odds of gastrointestinal complications. Conclusion: This study demonstrates differences in the types of CDI complications among IBD patients on immunosuppressive therapy. Follow up randomized control trials would be necessary to identify true causal relationships. Significant reduction in rates of septic shock may owe to more cautious management among physicians who correctly deem immunocompromised patients as high-risk. Nonetheless, the pervasiveness of CDI sequela across the study cohorts suggests that all IBD patients, regardless of immune system status, require intensive monitoring when there is concern for CDI.