Excess hospitalization burden associated with Clostridium difficile in patients with Inflammatory Bowel Disease

Abstract

Objectives: Clostridium difficile (C difficile) is an important cause of diarrhea in hospitalized patients. There are an increasing number of cases of C difficile colitis in patients with inflammatory bowel disease (IBD; Crohn's disease (CD), Ulcerative colitis (UC)). We performed this study to estimate the potential excess in morbidity and mortality associated with C difficile in hospitalized patients with IBD.

Methods: We analyzed data from the Nationwide Inpatient Sample (2003) and examined outcomes of patients hospitalized with both C difficile colitis and IBD compared to those hospitalized for either condition alone. Our primary outcome was in-hospital mortality. We also performed subgroup analysis comparing outcomes of C difficile infection in patients with CD and UC.

Results: There were 2,804 discharges with a diagnosis of both C difficile and IBD, 44,400 discharges with a diagnosis of C difficile alone, and 77,366 discharges with a diagnosis of IBD alone. On multivariate analysis, patients in the C difficile-IBD group had a four times greater mortality than patients hospitalized for IBD alone (aOR 4.7, 95% CI 2.9 - 7.9) of C difficile alone(aOR 2.2, 95% CI 1.4 - 3.4), and stayed in the hospital for three days longer (3.0 days, 95% CI 2.3 – 3.7). We found significantly higher mortality, endoscopy and surgery rates in patients with UC compared to CD (p<0.05), but no significant difference in length of stay or median hospital charge between the two groups.

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