Su1931 PATIENT-REPORTED SYMPTOMS OVER A PERIOD OF 14 DAYS RELIABLY PREDICT ENDOSCOPIC AND HISTOLOGICAL DISEASE ACTIVITY IN ULCERATIVE COLITIS (UC)

Background: Clostridioides difficile infection (CDI) in patients with inflammatory bowel disease (IBD) is associated with increased morbidity and mortality.Differentiating colonization (which is more common in patients with IBD) from true infection is important in the management of hospitalized patients with IBD.Polymerase Chain Reaction (PCR) Cycle threshold (Ct) is an embedded result within the 2-step C.difficile assay that measures test positivity, and theoretically determines bacterial burden in stool.The aim of this study was to investigate if PCR Ct can help differentiate colonization from severe infection in hospitalized IBD patients with a diagnosis of C .difficile.Methods: A cohort of hospitalized patients was identified between May 2018 and Oct 2019 by the microbiology lab as having an initial indeterminate C. difficile toxin test (positive glutamate dehydrogenase antigen and negative Toxin A and B) which reflexed to a second stage confirmatory laboratory-developed PCR test.A retrospective chart review was undertaken and patient demographics collected.Patients were stratified as having IBD (Ulcerative Colitis or Crohn's Disease) by ICD10 codes which were confirmed by direct chart review.Severity was defined as having an albumin level <3 g/dL, acute kidney injury (creatinine elevation by 50% from baseline or increase by .3mg/ dL in two days) or WBC >15,000 cells/mm.A multivariable model which included, age, gender and IBD status was performed to assess Ct and CDI severity.Results: A total of 106 patients who underwent C. difficile PCR testing between May 2018 and Oct 2019 with a mean age of 62 ± 19 years were included in the analysis.Among them, 13 (12%) had IBD and 51 (48%) were classified as severe.Mean Ct was 29.7 ± 3.6 for patients without severe outcomes vs. 30.2± 2.9 for patients with severe outcomes (p=0.37,table 1).After adjusting for age and gender in the multivariable model, neither IBD nor Ct was significantly associated with severity.The interactive effects between IBD and Ct on severity were not explored in the multivariable model due to the low number of patients with IBD.However, based on the box plots of Ct in Figure 1, the pattern of cycle time between severe and non-severe patients were similar in IBD and non IBD groups.Conclusions: PCR Cycle threshold did not help differentiate colonization from severe infection in hospitalized patients with Inflammatory Bowel Disease.Although data correlating Ct and CDI severity in IBD patients is limited, our preliminary results suggest that IBD patients may demonstrate a similar clinical pattern as the general population, in which several studies have validated Ct as a potential marker of colonization.The study is ongoing with additional patients being enrolled, with our continuing aim to further clarify the potential use of Ct in IBD patients.