Faculty Collaboration Database

Temporal trends in disease outcomes related to Clostridium difficile infection in patients with inflammatory bowel disease. Inflamm Bowel Dis 2011 Apr;17(4):976-83

Date

09/09/2010

Pubmed ID

20824818

DOI

10.1002/ibd.21457

Scopus ID

2-s2.0-79952458766 (requires institutional sign-in at Scopus site)   128 Citations

Abstract

BACKGROUND: Clostridium difficile has emerged as an important pathogen in patients with inflammatory bowel disease (IBD) and is associated with increased morbidity and mortality. No studies have examined the temporal change in severity of C. difficile infection (CDI) complicating IBD.

METHODS: Using data from the Nationwide Inpatient Sample, we identified all IBD-related hospitalizations during the years 1998, 2004, and 2007 and examined hospitalizations with a coexisting diagnosis of C. difficile. We compared the absolute outcomes of in-hospital mortality and colectomy in the C. difficile-IBD cohort during these timepoints, and also examined these outcomes relative to non-C. difficile IBD controls during each corresponding year.

RESULTS: During 1998, 2004, and 2007, approximately 1.4%, 2.3%, and 2.9% of all IBD hospitalizations nationwide were complicated by CDI (P < 0.001). The absolute mortality in the C. difficile-IBD cohort increased from 5.9%-7.2% (P = 0.052) with a nonsignificant increase in colectomy rate from 3.8%-4.5% between 1998 and 2007. Compared to non-C. difficile IBD controls, there was an increase in the relative mortality risk associated with C. difficile from 1998 (odds ratio [OR] 2.38, 95% confidence interval [CI]: 1.52-3.72) to 2007 (OR 3.38, 95% CI: 2.66-4.29) (P = 0.15) with a significant increase in total colectomy odds from 1998 (OR 1.39, 95% CI: 0.81-2.37) to 2007 (OR 2.51, 95% CI: 1.90-3.34) (P = 0.03).

CONCLUSION: There has been a temporal increase nationwide in CDI complicating IBD hospitalizations. The excess morbidity associated with C. difficile infection in hospitalized IBD patients has increased between 1998 and 2007.

Author List

Ananthakrishnan AN, McGinley EL, Saeian K, Binion DG

Author

Kia Saeian MD Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Adult
Aged
Clostridium Infections
Colitis, Ulcerative
Crohn Disease
Female
Hospital Mortality
Hospitalization
Humans
Male
Middle Aged
Risk Factors
Severity of Illness Index
Treatment Outcome
Young Adult