S1989 Clinical Outcomes Associated With Detection of Non-Clostridioides difficile Enteric Pathogens During IBD Flares

Introduction: Polymerase chain reaction (PCR)-based stool panels are routinely used to evaluate inflammatory bowel disease (IBD) flares. However, the clinical relevance of detecting non-Clostridioides difficile (non-C. diff) bacterial pathogens remains unclear. Given the high sensitivity of these tests, understanding how to interpret and manage positive results during IBD flares is critical. Methods: We performed a retrospective review of adult IBD patients admitted to a tertiary care center with a positive PCR stool test for non-C. diff bacterial pathogens. Patients were grouped based on initial therapy within 48 hours of the positive test: (1) antibiotics alone, (2) antibiotics plus steroids, (3) steroids alone, or (4) neither. The primary outcome was clinical improvement, defined as a reduction to <5 bowel movements/day with a concurrent CRP decrease at 72 hours. Secondary outcomes included need for rescue therapy or colectomy during admission, 90-day readmission, and therapy change or colectomy at 90 days. Results: A total of 43 patients met inclusion criteria. Among those who received antibiotics alone (n = 21), 62% achieved the primary outcome, 10% did not improve, and 28% had subjective (but not objective) improvement. One patient (5%) required rescue therapy. Readmission rate was 33%, with 14% requiring a therapy change and 5% undergoing colectomy at 90 days. In the antibiotics plus steroids group (n = 12), 83% improved, none required rescue therapy, 33% were readmitted, 58% needed a therapy change, and 8% underwent colectomy. Of the 10 patients who received either steroids alone (n = 4) or neither therapy (n = 6), 90% met the primary outcome, and none required rescue therapy or colectomy. Conclusion: High rates of clinical improvement were observed in our cohort regardless of management strategy. Readmission rates were similar between the dominant treatment strategies and colectomy rates were low which may suggest a limited role of antibiotics in the management of these positive tests. This is further supported by the observation that, despite the high frequency of antibiotic administration (77%), even those patients that did not receive antibiotics had favorable outcomes. This implies that a positive stool test may signify colonization of these bacteria rather than representing a true pathogen. Although limited by small sample size and retrospective design, these findings highlight the need for prospective studies to clarify the clinical utility of stool PCR testing in this population.