P1596 - Comparative Analysis of Clostridium difficile Infection Outcomes in Patient With Solid Organ Transplant vs Without Solid Organ Transplant in the United States

Fnu Vikash, MD¹, Vikash Kumar, MD², Noor Syed, MD³, Sobaan Taj, MD⁴, Hassam Ali, MD⁵, Chun-Wei Pan, MD⁶, Osayande Osagiede, MD, MPH⁷, Yassine Kilani, MD⁸, Talia F.. Malik, MD⁹, Clive J. Miranda, DO, MS¹⁰, Sana Hussain, MD¹¹, Sindhu Vikash, MD¹, Sunny Patel, MD^12
1Albert Einstein College of Medicine, Jacobi Medical Center, Bronx, NY; ²Brooklyn Hospital Center, Brooklyn, NY; ³Santa Clara Valley Medical Center, San Jose, CA; ⁴Hackensack Meridian Jersey Shore University Medical Center, Neptune, NJ; ⁵East Carolina University, Greenville, NC; ⁶John H. Stroger, Jr. Hospital of Cook County, Chicago, IL; ⁷Mayo Clinic Hospital, Jacksonville, NY; ⁸Lincoln Medical Center, New York, NY; ⁹Chicago Medical School at Rosalind Franklin University of Medicine and Science, North Chicago, IL; ¹⁰University at Buffalo, Buffalo, NY; ¹¹Khyber Teaching Hospital, Peshawar, Northern Areas, Pakistan; ¹²Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY

Introduction: Clostridium Difficile Infection (CDI) is notorious for its substantial healthcare burden in the United States (US). Solid organ transplant (SOT) recipients are at an increased risk for CDI. A recent study showed an overall improvement in mortality in patients hospitalized with CDI. However, it is unknown if this benefit extends to SOT recipients. Our study aimed to elucidate the differences in outcomes of CDI in patients with SOT compared to without SOT.

Methods: This is a retrospective longitudinal study using the US National Inpatient Sample (NIS) database from 2016 to 2020. We compared adult patients admitted with a primary diagnosis of CDI and cohorted the patients to either have a history of SOT (Liver, Pancreas, Kidney, Heart, and Lung) or not using ICD-10-CM codes. The baseline characteristics of patients were compared using t-test and chi-square tests. Multivariate regression analysis (adjusting for confounders) was applied to estimate: length of hospital stay (LOS), total hospital charges, and mortality. All p-values < 0.05 were statistically significant.

Results: A total of 875,775 adults with CDI were identified; among them, 1.8% (n=15,870) were SOT recipients. The CDI SOT cohort was younger (mean age 59 vs. 65 years; p=0.0001) and had a higher LOS (10 vs. 7 days; p=0.0001) than the CDI without SOT cohort. This cohort had a higher proportion of Whites (63%; p=0.01), males (53%; p=0.001), and higher socioeconomic status (p=0.001). These patients were also less likely to smoke (4% vs. 13%, p = 0.0001) or consume alcohol (2% vs. 6.5%, p=0.0001) than the CDI without SOT cohort. The CDI SOT cohort had lower odds of mortality aOR 0.5 (p=0.0001), intestinal perforation aOR=0.2 (p=0.005), colectomy aOR=0.3 (p=0.001), sepsis aOR=0.8 (p=0.04), and septic shock aOR=0.6 (p=0.001). There was no statistically significant difference in the rates of peritonitis (p=0.08), toxic megacolon (p=0.35), or organ infection (p=0.07) (Table 1).

Discussion: Our study demonstrates that hospitalization for CDI in patients with SOT had a higher LOS, though interestingly, a lower rate of severe complications and decreased mortality compared to patients hospitalized with CDI without SOT. This may be attributed to early recognition and hospitalization for CDI, caution around their immunosuppressed status, and perhaps continuing a longer length of stay to monitor symptoms closely. Additional large prospective studies are needed to validate our findings and characterize factors that led to the study findings.


Disclosures:


Fnu Vikash, MD¹, Vikash Kumar, MD², Noor Syed, MD³, Sobaan Taj, MD⁴, Hassam Ali, MD⁵, Chun-Wei Pan, MD⁶, Osayande Osagiede, MD, MPH⁷, Yassine Kilani, MD⁸, Talia F.. Malik, MD⁹, Clive J. Miranda, DO, MS¹⁰, Sana Hussain, MD¹¹, Sindhu Vikash, MD¹, Sunny Patel, MD¹². P1596 - Comparative Analysis of Clostridium difficile Infection Outcomes in Patient With Solid Organ Transplant vs Without Solid Organ Transplant in the United States, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.