C. difficile trends in hospitalized IBD patients

April 15, 2024

Issue 08

Clinical Question

What are the risk factors for C. difficile infection and mortality in hospitalized IBD patients?

Editor’s Bottom Line

Although rates seem to have stabilized, Clostridioides difficile infection remains common in hospitalized IBD patients and is a predictor of adverse outcomes.

Reference

Spartz EJ, DeDecker LC, Fansiwala KM, et al. Recent trends and risk factors associated with Clostridioides difficile infections in hospitalized patients with inflammatory bowel disease. Aliment Pharmacol Ther. 2024;59(1):89–99; https://onlinelibrary.wiley.com/

Synopsis

In this retrospective analysis, researchers examined data from the United States’ Nationwide Readmissions Database and found 2,521,935 patients with IBD who were hospitalized at least once between 2010 and 2020. They documented rates of Clostridioides difficile infection (CDI) using International Classification of Diseases (ICD) codes and performed statistical analyses to identify patient- and hospital-related risk factors.

Rates of CDI increased from 1.64% to 3.32% between 2010 and 2015, respectively, in Crohn’s disease (CD) patients, and from 4.15% to 5.81%, respectively, in ulcerative colitis (UC) patients (p<0.001). CDI rates retreated slightly by 2020, dropping to 2.27% and 4.27% in the CD and UC patient populations, respectively (p<0.001).

Statistical analyses identified a number of risk factors for CDI, including higher Charlson-Deyo comorbidity index (Odds Ratio for CD: 1.10, 95% Confidence Interval [CI], 1.04–1.16, p<0.001; OR for UC: 1.10; 95% CI, 1.06–1.15; p<0.001), public insurance (OR for CD: 1.23; 95% CI, 1.15–1.32; p<0.001 and OR for UC: 1.18; 95% CI, 1.12–1.24; p<0.001), hospital size (OR for CD: 1.13; 95% CI, 1.03–1.24; p=0.011 and OR for UC: 1.09; 95% CI, 1.01–1.17; p=0.026), and treatment in an urban teaching hospital (OR for CD: 1.29; 95% CI, 1.2–1.39; p<0.001 and OR for UC: 1.08; 95% CI, 1.02–1.14; p=0.006). Females were at slightly higher risk of CDI than males among those with UC (OR: 1.06; 95% CI, 1.02–1.12; p=0.009).

Analyses also showed that CD patients with CDI were 24% more likely to have a hospital readmission within 30 days, compared to CD patients without CDI (OR: 1.24; 95% CI, 1.14–1.36; p<0.001). There was no such association among UC patients.

Both CD and UC patients with CDI were more likely to die during the study period (OR for CD: 2.69; 95% CI, 1.07–2.48; p<0.001 and OR for UC: 4.26; 95% CI, 3.79–4.8; p<0.001). Age and number of comorbidities were associated with mortality in all IBD patients with CDI.

Details

Study Design: Nationwide retrospective database analysis
Funding: None
Allocation: Not applicable
Setting: Multicenter
Level of Evidence: 2b