Excess hospitalisation burden associated with Clostridium difficile in patients with inflammatory bowel disease.
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.
Ananthakrishnan
A N
AN
Division of Gastroenterology and Hepatology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
McGinley
E L
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Binion
D G
DG
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016360:Clostridioides difficile / Q000302:isolation & purification*; D003015:Clostridium Infections / Q000175:diagnosis / Q000191:economics*; D017281:Cost of Illness; D005260:Female; D006760:Hospitalization / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000150:complications / Q000191:economics* / Q000401:mortality; D008297:Male; D008875:Middle Aged