Risk Factors for Clostridium difficile Infections in Patients Hospitalized With Acute Pancreatitis

Abstract

Introduction: Acute pancreatitis is the most common principle GI reason for hospital admission. Antibiotics are often given to patient with pancreatitis especially if there is concern for infection. Clostridium difficile infection (CDI) is exponentially increasing in hospitalized patients. Methods: A retrospective analysis was performed on a subset of patients with acute pancreatitis from the NIS database. A logistic regression model was built to identify predictors of CDI in patients with pancreatitis. Variables felt a priori to be risk factors for CDI were included in the model. Results: 2,569,410 patients with acute pancreatitis were identified. Of those, 22,469 patients had CDI (0.9%) during the index admission. Several variables were found to increase the odds of CDI during hospitalization. These include a diagnosis of ulcerative colitis (OR 3.8, 95%CI 3.3-4.3, p < 0.001), use of TPN (OR 2.9, 95%CI 2.8-3.0, p < 0.001), infection (OR 2.5, 95%CI 2.4-2.5, p < 0.001), use of enteral feeds (OR 2.1, 95%CI 1.9-2.3, p < 0.001) and high comorbid score (Charlson Comorbidity Index≥3 OR 2.1, 95%CI 2.0-2.2, p < 0.001). Conclusion: Acute pancreatitis is a common cause of hospital admission. Patients with severe disease are often given antibiotics, though antibiotics are not needed for sterile necrosis. There has been an increasing trend of c. difficile infections complicating hospitalizations for acute pancreatitis. Patients with concurrent infections are likely to get antibiotics, which puts them at risk. However, risk factors such as TPN and enteral feeding suggest patients with more severe disease are more at risk for c. difficile infections. In these patients antibiotics should be used very judiciously given this increase risk.