Results: 14/980 (1.4%) of patients with IBD at EH had at least one episode of symptomatic CDI (2005–2014). Of 14 IBD patients, 8 (57%) had ulcerative colitis, 6 (43%) had Crohn’s, mean age was 46 y, 9 (65%) were females, with mean Charlson comorbidity index score for the IBD patient cohort was 1.2. 0/14 (0 %) patients had a recent course of broad-spectrum antibiotics. 12 (86%) patients were on immunosuppressants at time
of CDI, 5/14 (35 %) had therapy for IBD escalated during admission. Matching ensured no significant differences in age, sex or Charlson comorbidity index between the IBD patients and non-IBD controls (each p > 0.30). IBD patients with CDI were significantly Roxadustat different from non-IBD controls with CDI in multiple aspects including that IBD patients were more likely to have acquired CDI as an outpatient (Fisher exact test, p = 0.003), had not received recent antibiotics (including broad spectrum antibiotics known to increase risk of CDI) (p < 0.001), been on immunosuppressant therapy (p = 0.002), presented with abdominal pain (p = 0.05) and failed initial treatment with metronidazole (p = 0.003). Also, compared with non-IBD controls, those with IBD on average had more bowel actions/ day at presentation (mean 6 vs 2, t-test, p < 0.05), required
longer duration of antibiotics before clinical improvement (mean 23 vs 10 days, selleck compound p < 0.05) and tended to have lower serum CRP but higher albumin (mean 15 vs 26 (p = 0.09) 37 vs 33 (p = 0.07) respectively. There was no significant difference in length
of inpatient stay caused by CDI between the IBD and non-IBD groups (mean 7.0 vs 5.8, p = 0.30). Conclusion: CDI was relatively uncommon in IBD with a prevalence of approximately 1%, but when it occurs it is more likely outpatient acquired, less responsive to standard antibiotic therapy and duration and associated with concurrent immunosuppression rather than the typical recent use of broad spectrum antibiotics. Consideration should be given to early or even first line use of oral vancomycin in IBD patients see more with CDI given the poor, slower response to metronidazole, but further studies are needed. DK TIAO,1 J JEGANATHAN,1 A CHEN,2 J CHANG,3 CP SELINGER,3 RWL LEONG3 1Faculty of Medicine, The University of Sydney, 2Faculty of Medicine, The University of New South Wales, 3Gastroenterology and Liver Services, Concord Hospital, Sydney, NSW, Australia Background: Inflammatory bowel diseases (IBD) often require chronic maintenance medical therapy. Non-adherence occurs in up to 40% of patients, and is associated with increased relapse rates. The Medication Belief Model of perceived medication necessity versus concerns aims to shift patients’ attitudes towards ‘acceptance’ (high necessity and low concerns).