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597: RECTAL VANCOMYCIN IRRIGATION POST-COLECTOMY FOR CLOSTRIDIUM DIFFICILE TOXIC COLITIS

Learning Objectives: Clostridium difficile infection (CDI) accounts for up to 25% of episodes of antibiotic-associated diarrhea and is the most common cause of healthcare-associated diarrhea. Rectal vancomycin irrigation (PRV) is a therapeutic option; however evidence is limited for use post-colectomy. The objective of this study is to describe the impact of PRV in patients who underwent colectomy for toxic C. difficile colitis. Methods: This was a retrospective, single-center, observational study of adult patients who underwent colectomy for CDI between January 1, 2011 and December 31, 2016. Patients who received PRV post-colectomy were compared to those who did not (no-PRV) with a primary outcome of all-cause hospital mortality. Secondary efficacy outcomes included intensive care unit (ICU) and hospital length of stay (LOS), ventilator-free days at day 28 post-colectomy, proctitis or pseudomembranes, re-initiation of CDI therapy, and normalization of infectious signs and symptoms at CDI therapy completion. The primary safety outcome was rectal stump blowout. Continuous variables are reported as median [IQR] and were analyzed using the Mann-Whitney U test. Nominal data are reported as percent and were analyzed using either the chi-squared or Fisher’s exact test as appropriate. Results: A total of 50 patients were included (38 PRV; 12 no-PRV). Baseline demographics were similar between groups, however significantly more PRV patients were admitted with sepsis/septic shock (18.4 vs. 0%, p<0.01). Duration of PRV therapy post-colectomy was 5 [4–8] days. No difference was observed between PRV and no-PRV groups for the primary outcome of all-cause mortality (39.5 vs 33.3%, p>0.99). There was no significant difference between groups for hospital LOS, but there was a trend toward longer ICU LOS for PRV patients (9.5 [5–17] vs. 2.5 [1.5–13.5] days, p=0.050). There were no differences in the remaining secondary efficacy outcomes. No episodes of rectal stump blowout were observed in either group. Conclusions: As there were no significant clinical benefits observed with PRV, these results do not support routine recommendation of rectal vancomycin irrigations. However, as no episodes of rectal stump blowout were observed, they suggest this therapy may be a safe option for patients with severe CDI requiring colectomy.