S1915 Assessing Recurrent Rates of Clostridiodes difficile Infection in Patients With Inflammatory Bowel Disease Following 10- vs 14-Days of Oral Vancomycin for Initial CDI Episode

Introduction: Patients with inflammatory bowel disease (IBD) are more likely to experience recurrent CDI (rCDI) compared to the non-IBD population. Oral vancomycin (OV) is commonly used for CDI, but data on how treatment duration affects outcomes in IBD patients is limited. In this study, we aimed to compare rCDI rates among IBD patients treated with either 10 or 14 days of OV for a first episode, and we also sought to assess risk factors of rCDI. Methods: A retrospective review of electronic health records from a tertiary care center between 2014-2024 was conducted to identify IBD patients with a history of a first episode of CDI treated with OV. The following data were obtained: baseline demographics, details of IBD history, treatment course of first CDI, and rCDI. Treatment durations of 10 and 14 days were compared, and statistical analysis was done with chi-square tests and multiple logistic regression. Results: A total of 210 patients (median age 49 yrs [range 20-95 yrs], 48.6% women, 72.4% White) were identified with a diagnosis of IBD and CDI treated with OV 125 mg. 29 of the cases represented rCDI (13.8%). Most patients had UC (n = 113, 53.8%) compared to Crohn’s (n = 97, 46.2%). Fewer than 50% of patients were on biologics for IBD at the time of CDI diagnosis. Treatment of IBD with biologics was a potential protective factor for rCDI (OR 0.27, 95% CI: 0.09-0.75). Just over half of patients were on a 10-day treatment of OV (59%) compared to a 14-day course (41%), with no significant difference in the odds of rCDI between the 2 treatment durations (P = 0.13). On multivariate analysis, biologic use decreased the risk of rCDI (aOR 0.26, 95% CI: 0.08-0.74; P = 0.016), while duration of treatment 10 v 14 days (P = 0.994), surgical history (P = 0.202), IBD type (P = 0.211), gender (P = 0.769), age at CDI diagnosis (P = 0.818) did not affect the risk of rCDI. Conclusion: There was no significant difference in the risk of rCDI between patients who received 125 mg of OV for 10 days compared to those treated for 14 days, demonstrating that treatment with 10 days of OV may be safe for IBD patients. We found that biologics may be protective against rCDI. Larger, prospective studies are needed to confirm these findings and to evaluate the risks and benefits of 10 vs 14 days of OV treatment.