Mo1287 Older Hospitalized Patients With Ribotype 027 Clostridium difficile Infection and Stool Toxin Have More Intestinal Inflammation and an Increased Risk of Death

OBJECTIVES/SPECIFIC AIMS: Clostridium Difficile Infection (CDI), a prevalent cause of diarrhea, is the most notorious hospital-acquired infection, resulting in an alarming mortality and health care utilization rates. Herein, we investigate the impact of cannabis use, which is gaining significant legalization for recreational use, on the risk of CDI. METHODS/STUDY POPULATION: We selected adult records (age ≥ 18 years) from the Nationwide Inpatient Sample 2014, and identified cannabis users and other clinical conditions using ICD-9-CM codes. With multivariate logistic modeling, we generated propensity scores for cannabis users and matched them to non-users in a 1:1 ratio (104,936:104,936). We then estimated the adjusted relative risk (aRR) for having CDI using conditional Possion regression models with generalized estimating equations [SAS 9.4]. RESULTS/ANTICIPATED RESULTS: Among the matched hospitalizations (n=209,872), cannabis usage was associated with a reduced incidence of CDI (505.8[464.7-550.6] vs. 694.9[645.8-747.70] per 100,000 hospitalizations), resulting in a 27% reduced risk of CDI (aRR:0.73[0.65-0.81]; p-value:<0.0001). Non-dependent and dependent cannabis users respectively had 22% and 78% reduced likelihood of CDI when compared to non-cannabis users (0.78[0.69-0.90] & 0.22[0.12-0.40]). Furthermore, dependent users had less risk of CDI compared to non-dependent users (0.28[0.16-0.51]). Comparatively, abusive use of other substances like alcohol and tobacco was associated with increased risk for CDI (1.30[1.13-1.49] & 1.24[1.10-1.40]) DISCUSSION/SIGNIFICANCE OF IMPACT: Unlike alcohol and tobacco abuse which are associated with elevated risk for CDI, cannabis use, is related to a decreased risk of CDI amongst hospitalized patients. Further prospective and molecular mechanistic studies are required to elucidate how cannabis impacts CDI.

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Impact of clostridium difficile infection on gastrointestinal malignancies.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.4_suppl.170 ◽

2019 ◽

Vol 37 (4_suppl) ◽

pp. 170-170

Author(s):

Stuthi Perimbeti ◽

Rishi Shrivastav ◽

Prateeth Pati ◽

Kristine Marie Ward ◽

Michael Styler ◽

...

Keyword(s):

Clostridium Difficile ◽

Clostridium Difficile Infection ◽

Primary Diagnosis ◽

Chi Square ◽

Gastrointestinal Malignancies ◽

Risk Of Death ◽

Cox Proportional Hazard ◽

Increased Risk ◽

Control And Prevention ◽

Chi Square Test

170 Background: According to the Centers for Disease Control and Prevention, there were half a million documented cases with 83,000 re-infections and 29,000 deaths due to Clostridium Difficile Infection(CDI) in the year 2011. The influence of CDI on outcomes in gastrointestinal(GI) malignancies is not well described, although the incidence is known to be higher in this subgroup of patients. Methods: National Inpatient Sample 1999-2014 was analyzed to identify adult admissions (>18 years of age) using ICD-9-CM codes with a primary diagnosis of esophageal(EC), Gastric(GC), Colorectal(CRC), Small intestinal(SIC), Hepatobiliary(HCC) and Pancreatic(PC) cancers. ICD-9 code 00845 was used to stratify these for the presence of CDI. We performed Chi-Square test to determine the in-hospital mortality percentage, and Cox Proportional Hazard model to control for confounders and determine the Hazard Ratio(HR) of death within 30 days of admission during hospitalization in patients with and without CDI. Results: See table. Conclusions: Despite controlling for potential confounders, patients with GI cancers and CDI are at an increased risk of death compared to those without CDI. Taking the more detrimental effects of CDI in this subgroup of patients into consideration, healthcare professionals should strive to avoid the inordinate use of antibiotics and strictly maintain current guidelines designed to prevent spread. It may be prudent to treat these patients as severe CDI, even if current criteria are not met. More scientific research is warranted in analyzing the specific outcomes of CDI in GI cancer patients and if more aggressive therapy for CDI is warranted, considering the limitations of this study. [Table: see text]

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Faculty Opinions recommendation of Clostridium difficile infection is associated with increased risk of death and prolonged hospitalization in children.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.717998875.793481855 ◽

2013 ◽

Author(s):

Jason Newland

Keyword(s):

Clostridium Difficile ◽

Clostridium Difficile Infection ◽

Risk Of Death ◽

Prolonged Hospitalization ◽

Increased Risk

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Proton Pump Inhibitor use in Hospitalized Patients: Is Overutilization Becoming a Problem?

Clinical Medicine Insights Gastroenterology ◽

10.4137/cgast.s9588 ◽

2012 ◽

Vol 5 ◽

pp. CGast.S9588 ◽

Cited By ~ 14

Author(s):

Cheryl Durand ◽

Kristine C. Willett ◽

Alicia R. Desilets

Keyword(s):

Clostridium Difficile ◽

Proton Pump Inhibitor ◽

Proton Pump Inhibitors ◽

Proton Pump ◽

Clostridium Difficile Infection ◽

Adverse Reactions ◽

Recent Literature ◽

Hospitalized Patients ◽

Increased Risk ◽

Appropriate Therapy

Proton pump inhibitors (PPIs) are among the most common classes of medications prescribed. Though they were previously thought of as safe, recent literature has shown risks associated with their use including increased risk for Clostridium difficile infection, pneumonia, and fractures. Due to these risks, it is important to determine if PPIs are being used appropriately. This review evaluates seven studies in hospitalized patients. Additionally, this review evaluates literature pertaining to recently discovered adverse reactions; all studies found PPIs are being overutilized. Findings highlight the importance of evaluating appropriate therapy with these agents and recommending discontinuation if a proper indication does not exist.

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Institutionalized Residents have Increased Risk of Death Following Hospitalization with Clostridium Difficile Infection

Journal of the American Medical Directors Association ◽

10.1016/j.jamda.2012.12.067 ◽

2013 ◽

Vol 14 (3) ◽

pp. B23-B24

Author(s):

Laurie R. Archbald-Pannone ◽

Tim McMurry ◽

Richard Guerrant

Keyword(s):

Clostridium Difficile ◽

Clostridium Difficile Infection ◽

Risk Of Death ◽

Increased Risk

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Impact of Clostridium difficile infection on gastrointestinal malignancies.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.e15586 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. e15586-e15586

Author(s):

Stuthi Perimbeti ◽

Rishi Shrivastav ◽

Karan Jatwani ◽

Kristine Marie Ward ◽

Michael Styler ◽

...

Keyword(s):

Clostridium Difficile ◽

Clostridium Difficile Infection ◽

Primary Diagnosis ◽

Chi Square ◽

Gastrointestinal Malignancies ◽

Risk Of Death ◽

Cox Proportional Hazard ◽

Increased Risk ◽

Control And Prevention ◽

Chi Square Test

e15586 Background: According to the Centers for Disease Control and Prevention, there were half a million documented cases with 83,000 re-infections and 29,000 deaths due to Clostridium Difficile Infection(CDI) in the year 2011. The influence of CDI on outcomes in gastrointestinal(GI) malignancies is not well described, although the incidence is known to be higher in this subgroup of patients. Methods: National Inpatient Sample 1999-2014 was analyzed to identify adult admissions (>18 years of age) using ICD-9-CM codes with a primary diagnosis of esophageal(EC), Gastric(GC), Colorectal(CRC), Small intestinal(SIC), Hepatobiliary(HCC) and Pancreatic(PC) cancers. ICD-9 code 00845 was used to stratify these for the presence of CDI. We performed Chi-Square test to determine the in-hospital mortality percentage, and Cox Proportional Hazard model to control for confounders and determine the Hazard Ratio(HR) of death within 30 days of admission during hospitalization in patients with and without CDI. Results: See Table. Conclusions: Despite controlling for potential confounders, patients with GI cancers and CDI are at an increased risk of death compared to those without CDI. Taking the more detrimental effects of CDI in this subgroup of patients into consideration, healthcare professionals should strive to avoid the inordinate use of antibiotics and strictly maintain current guidelines designed to prevent spread. It may be prudent to treat these patients as severe CDI, even if current criteria are not met. More scientific research is warranted in analyzing the specific outcomes of CDI in GI cancer patients and if more aggressive therapy for CDI is warranted, considering the limitations of this study. [Table: see text]

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