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

Division of Gastroenterology and Hepatology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
Gut (Impact Factor: 14.66). 03/2008; 57(2):205-10. DOI: 10.1136/gut.2007.128231
Source: PubMed


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).
To estimate the potential excess morbidity and mortality associated with C difficile in hospitalised patients with IBD.
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.
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.
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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Available from: David G. Binion, Jun 15, 2015
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    • "Issa et al. found that the incidence of CDAD in patients with IBD increased from 1.8% in 2004 to 4.6% in 2005, and patients with IBD involving the colon tended to be infected more frequently [7, 8]. Ananthakrishnan et al. found patients with IBD and CDAD were hospitalised more frequently, and that the frequency grew over time from 24/1000 cases in 1998 to 39/1000 cases in 2004 for UC patients and 8/1000 in 1998 to 12/1000 in 2004 for CD patients [9]. "
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    ABSTRACT: Clostridium difficile is a bacterium widely distributed in the human environment. In the last decade the incidence and severity of Clostridium difficile infection has grown, particularly in Europe and North America, making it one of the more common nosocomial infections. A group particularly susceptible to Clostridium difficile infection are patients with inflammatory bowel disease, especially those with involvement of the colon. This paper presents relevant data on Clostridium difficile infections in inflammatory bowel disease patients, including epidemiology, pathogenesis, diagnosis and treatment.
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    • "It is possible that a number of the colectomies were performed for underlying IBD or for another clinical indication. If C. difficile is detected during an IBD exacerbation, it has been shown to be a marker for severity and increased in-hospital mortality [21]. However, among both pediatric patients with IBD and non-IBD controls, toxigenic C. difficile is frequently detected irrespective of symptoms [22]. "
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    • "C. difficile is a Gram-positive, spore-forming anaerobic bacillus. There has been a significant increase in the proportion of hospitalizations complicated by C. difficile infection (CDI) from 1998–2004 (7/1000 versus 11/1000; P < 0.05).25 Acquisition of the infection occurs more frequently in those with recognized risk factors, including age > 65 years, prolonged hospitalization, solid organ transplantation, immunosuppression, use of high risk medications (eg, corticosteroids, anti-TNF therapy, antibiotics such as cephalosporin, clindamycin, and fluoroquinolones), and IBD (ulcerative colitis, Crohn’s disease).26 "
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