Incidence and Outcome of Clostridium difficile Infection in Hospitalized Patients with Inflammatory Bowel Disease in the UK.
OBJECTIVE
Previous studies have reported that Clostridium difficile infection [CDI] is more common, and has a worse outcome, in patients with inflammatory bowel disease [IBD] than in those without. We have now reassessed the incidence and outcome of CDI in in-patients with and without IBD, and the outcomes of admissions for IBD patients with and without CDI.


METHODS
In-patients who had stool samples submitted for C. difficile testing [2007-2013] were collated. Two matched pools were generated: patients with IBD and CDI vs non-IBD patients with CDI [matched for age, sex and date] and patients with IBD and CDI vs IBD patients without CDI [matched for age and IBD type]. For each group, admission details, pre-admission and outcome data were compared.


RESULTS
Four per cent [1079/21035] of samples were positive for CDI; 5% [49] of these were from IBD in-patients. The incidence of CDI in IBD patients decreased from 8.7% in 2007/08 to 0.4% in 2012/13 [p < 0.0001]. Length of stay was shorter in IBD patients with CDI than in non-IBD CDI patients (hazard ratio [HR] 0.335 [0.218-0.513]) and was no different between IBD patients with and without CDI (HR 0.661 [0.413-1.06]). IBD patients were diagnosed with CDI earlier in their admission than non-IBD patients (HR 0.182 [0.093-0.246]). No differences in mortality were found.


CONCLUSIONS
The incidence of CDI complicating IBD has fallen since 2007. CDI is no longer associated with worse short-term outcomes in patients with IBD than in those without. Patients with CDI and IBD have similar outcomes to those with IBD alone.
Centre for Immunobiology, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary, University of London, UK.
Neerav M
NM
Joshi
Centre for Immunobiology, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary, University of London, UK.
Isobel H
IH
Marks
Centre for Immunobiology, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary, University of London, UK.
Richard
R
Crowson
Department of Medical Microbiology, Barts Health NHS Trust, London, UK.
David
D
Ball
Centre for Immunobiology, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary, University of London, UK d.rampton@qmul.ac.uk.
David S
DS
Rampton
D000368:Aged; D016022:Case-Control Studies; D016360:Clostridioides difficile; D004761:Enterocolitis, Pseudomembranous / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D015212:Inflammatory Bowel Diseases / Q000150:complications*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D006113:United Kingdom / Q000453:epidemiology
Epidemiology; microbiology