133 Impact of Clostridium difficile Infection in Patients With Ulcerative Colitis and Crohn's Disease: A Comparative Analysis

Abstract

INTRODUCTION: Patients with Inflammatory bowel disease (IBD) are at increased risk of acquiring Clostridium difficile infection (CDI) that leads to an increased in morbidity and mortality. The aim of our study is 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 USA. METHODS: A retrospective cohort analysis using the 2004–2014 Nationwide Inpatient Sample is performed. Adult hospitalized patients with IBD (subgrouped into UC and CD) with CDI were identified using validated ICD-9 codes. Outcomes include in-patient mortality, hospital charges, and length of stay (LOS) among two groups. Confounding factors such as age, sex, ethnicity, insurance status, hospital characteristics, and CDI are adjusted with univariate and multivariate regression models. RESULTS: Out of total 514,889 UC patient's hospitalizations, 24,783 (4.81%) discharges were related to CDI with mean age 60 ± 3 years and 60% female population. In comparison to that, out of 878,896 CD hospitalizations, 13,120 (1.49%) were related to CDI (see Table 1). In terms of outcomes, patients with UC + CDI had increased mortality (adjusted OR 3.003, 95% CI 2.65–3.39), P = 0.00 and LOS (8.0 days vs 6.5 days) and mean total charges difference of $16,739.33 as compared to UC patients without CDI. However, in contrast to CD patients with CDI, there was no significant difference in mortality (adjusted OR 0.60, 95% CI 0.40–0.90, P = 0.021), mean LOS (6.57 days vs 6.15 days) and total hospitalization charges ($34,137.16 VS $33,020.09) in comparison to CD patients without CDI. CONCLUSION: Our study results provide important insight on the effect of CDI on the outcome in patients with IBD. 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.