The Impact of C difficile on Hospitalized Patients With Ulcerative Colitis

Clostridium difficile infection (CDI) is associated with increased morbidity and mortality, and patients with inflammatory bowel disease (IBD) are at an increased risk of acquiring the bacterium.

In research presented as a poster at the American College of Gastroenterology’s Annual Scientific Meeting (ACG 2019) in San Antonio, Texas, a team of investigators set out to compare the outcomes of CDI on in-hospital mortality and resource utilization among adult hospitalized patients with ulcerative colitis (UC) and Crohn’s disease (CD) without CDI in the United States.

The retrospective cohort analysis, using data from the 2004-2014 National Inpatient Sample, relied on validated ICD-9 codes to identify adult hospitalized patients with IBD and CDI. The group was then divided in subgroups of patients with UC and CD, both with and without CDI. Investigators adjusted with univariate and multivariate regression models for confounding factors, such as age, sex, ethnicity, insurance status, hospital characteristics, and CDI.

Outcomes included in-patient mortality, hospital charges, and length of stay (LOS).

A total of 514,889 patients hospitalized with UC were included in the analysis. Of those, 4.81% (24,783) of discharges were related to CDI. Sixty percent of these patients were female with a mean age of 60 + 3 years. In comparison, out of 878,896 CD hospitalizations, 1.49% (13,120) were related to CDI.

Compared with UC patients without CDI, UC patients with CDI experienced increased mortality (adjusted odds ratio [OR] 3.003, 95% confidence interval [CI] 2.65-3.39, p = 0.00) and LOS (8.0 days vs 6.5 days). They also paid $16,739.33 more in total hospital charges ($50,426.93 VS $33,686.67).

There was no significant difference in mortality among CD patients with or without CDI (adjusted OR 0.60, 95% CI 0.40-0.90, p = 0.021). Similarly, there was no significant difference in LOS (6.57 days vs 6.15 days) or total hospitalization charges ($34,137.16 VS $33,020.09) for CD patients with CDI and without, respectively.

“Our study results provide important insight on the effect of CDI on the outcome in patients with IBD,” investigators concluded. “Surprisingly, we found that among US adults with UC and CD-related hospitalizations, CDI is associated with significantly subgrouped in-hospital mortality and healthcare utilization only in patients with UC, and CDI infection did not appear to affect the outcomes in the CD-related hospitalizations.”

The poster, “Impact of Clostridium difficile Infection in Patients With Ulcerative Colitis and Crohn's Disease: A Comparative Analysis,” was presented Sunday, October 27, 2019, at the American College of Gastroenterology Annual Scientific Meeting (ACG 2019) in San Antonio, Texas.