Inflammatory bowel disease

Excess hospitalisation burden associated with Clostridium difficile in patients with inflammatory bowel disease

A N Ananthakrishnan¹, E L McGinley², D G Binion¹

¹ Department of Medicine, Medical College of Wisconsin, Milwaukee, USA
² Department of Population Health, Medical College of Wisconsin, Milwaukee, USA

Dr D G Binion, Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, WI 53226, USA; dbinion{at}mcw.edu

Background: Clostridium difficile is an important cause of diarrhoea in hospitalised patients. An increasing number of cases of C difficile colitis occur in patients with inflammatory bowel disease (IBD)—Crohn’s disease (CD), ulcerative colitis (UC).

Objective: To estimate the potential excess morbidity and mortality associated with C difficile in hospitalised patients with IBD.

Methods: Data from the Nationwide Inpatient Sample (2003) were analysed and outcomes were examined of patients hospitalised with both C difficile colitis and IBD compared with those hospitalised for either condition alone. The primary outcome was in-hospital mortality. A subgroup analysis was also performed comparing outcomes of C difficile infection in patients with CD and UC.

Results: 2804 discharges were diagnosed as having both C difficile and IBD, 44 400 as having C difficile alone, and 77 366 as having IBD alone. On multivariate analysis, patients in the C difficile–IBD group had a four times greater mortality than patients admitted to hospital for IBD alone (aOR = 4.7, 95% CI 2.9 to 7.9) or C difficile alone (aOR = 2.2, 95% CI 1.4 to 3.4), and stayed in the hospital for three days longer (95% CI 2.3 to 3.7 days). Significantly higher mortality, endoscopy and surgery rates were found in patients with UC compared with CD (p<0.05), but no significant difference in length of stay or median hospital charge between the two groups was seen.

Conclusions: C difficile colitis is associated with a significant healthcare burden in hospitalised patients with IBD and carries a higher mortality than in patients with C difficile without underlying IBD.

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