859 The Impact of Inflammatory Bowel Disease on Admissions With Clostridium difficile Infection: A Nationwide Database Study

Abstract

INTRODUCTION: Clostridium difficile infection (CDI) is one of the most common healthcare-associated infections. It contributes to significant morbidity and mortality amongst hospitalized patients in the United States. Prior studies suggest worse outcomes of CDI in patients with inflammatory bowel disease (IBD). We conducted this study to evaluate the outcomes of CDI in patients with IBD from a nationwide sample (2012-2015). METHODS: The National Inpatient Sample (NIS) database between January 2012 and September 2015 was queried for CDI admissions using the International Classification of Diseases, Ninth Edition, Clinical Modification [ICD-9-CM] codes 008.45, 555.X, 556.X for diagnoses of CDI and IBD In-hospital mortality, use of hospital resources, length of stay (LOS), and total charges in USD were assessed. Outcomes were adjusted for risk factors and comorbid conditions. RESULTS: The study included 1,311,085 patients who were admitted between 2012 and 2105 for CDI. Out of all of the patients, 54,655 (4.2%) had concurrent IBD. After adjusting for confounding variables, the in-hospital mortality was higher [Odd Ration (OR): 1.45, 95% CI: 1.34-1.57 P < 0.001] for patients with IBD and they were more likely to have toxic megacolon (13.3% vs 4.2% P < 0.001). However, in CDI without IBD, LOS was longer [10.5 vs. 9.3 days, P < 0.001] and mean cost of hospitalization was significantly higher. CONCLUSION: In a nationwide population study, admissions with CDI, patients with a concurrent diagnosis of IBD had higher in-hospital mortality and were more likely to have toxic megacolon compared with non-IBD. However, hospital length of stay and total charges in USD were more in non-IBD. The discrepancy between high mortality and lower LOS and total charges in IBD vs non-IBD can be due to early mortality during hospitalization, the clinical presentation with severe CDI on admission, and/or development of grave complications in patients with CDI and IBD. Studies are needed to better understand the impact of IBD on CDI. Studies are also needed to examine the role of aggressive treatment of CDI in patients with IBD early in the course of hospitalization.