Faculty Collaboration Database

Excess hospitalisation burden associated with Clostridium difficile in patients with inflammatory bowel disease. Gut 2008 Feb;57(2):205-10

Date

10/02/2007

Pubmed ID

17905821

DOI

10.1136/gut.2007.128231

Scopus ID

2-s2.0-38549093523 (requires institutional sign-in at Scopus site)   357 Citations

Abstract

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.

Author List

Ananthakrishnan AN, McGinley EL, Binion DG

Author

Emily L. McGinley Biostatistician III in the Center for Advancing Population Science department at Medical College of Wisconsin

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

Adolescent
Adult
Aged
Aged, 80 and over
Clostridium Infections
Cost of Illness
Female
Hospitalization
Humans
Inflammatory Bowel Diseases
Male
Middle Aged