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Disproportionate rise in Clostridium difficile-associated hospitalizations among US youth with inflammatory bowel
Kelly C Sandberg1, Matthew M Davis, Achamyeleh Gebremariam
1*Division of Pediatric Gastroenterology †Child Health Evaluation and Research Unit, University of Michigan, Ann Arbor.
Insights
Clostridium difficile infection (CDI) significantly increased the burden of hospital care for children and young adults with inflammatory bowel disease (IBD) from 1997 to 2011. This rise in CDI-related hospitalizations led to longer stays, more hospital days, and higher costs for IBD patients.
Area of Science:
- Gastroenterology
- Infectious Diseases
- Pediatric Health
Background:
- Inflammatory bowel disease (IBD) affects children and young adults, increasing their vulnerability to infections.
- Clostridium difficile infection (CDI) is a significant healthcare-associated infection with potential for severe outcomes.
Purpose of the Study:
- To characterize the temporal changes in the burden of Clostridium difficile infection (CDI) on hospital care for pediatric and young adult patients with inflammatory bowel disease (IBD) in the United States.
- To quantify the impact of CDI on hospitalizations, length of stay, hospital days, colectomy rates, and healthcare charges in this population.
Main Methods:
- Retrospective analysis of nationally representative annual data.
- Inclusion of children and young adults diagnosed with IBD.
- Comparison of hospitalizations with and without CDI from 1997 to 2011.
Main Results:
- A five-fold increase in IBD hospitalizations with CDI was observed between 1997 and 2011.
- Hospitalizations with CDI had consistently longer lengths of stay, increased total hospital days, and substantially higher total charges compared to IBD hospitalizations without CDI.
- Patients with CDI had lower odds of colectomy.
Conclusions:
- A widening gap in healthcare burden exists between IBD hospitalizations with and without CDI.
- CDI-related hospitalizations impose disproportionately longer lengths of stay, more hospital days, and higher costs.
- Further research is needed to understand and mitigate this enlarging gap to improve clinical care for vulnerable IBD patients.
Objectives:
Our aim was to characterize the temporal changes in burden that Clostridium difficile infection (CDI) added to the hospital care of children and young adults with inflammatory bowel disease (IBD) in the United States.
Methods:
Retrospective analysis of annual, nationally representative samples of children and young adults with IBD.
Results:
There was a 5-fold increase in IBD hospitalizations with CDI from 1997 to 2011 (P for trend <0.01). During the same period, IBD hospitalizations without CDI increased 2-fold (P for trend <0.01). Mean length of stay for IBD hospitalizations with CDI was consistently longer than that for hospitalizations without CDI and did not significantly change over time (P for trend = 0.47). CDI-related total hospital days in the United States rose from 1702 to 10,194 days per million individuals per year from 1997 to 2011 (P for trend <0.01). Children and young adults hospitalized with CDI had a significantly lower odds of colectomy (0.31) compared with those without CDI. Total charges for CDI-related hospitalizations among children and young adults in the United States rose from $8.7 million in 1997 to $68.2 million in 2011.
Conclusions:
A widening gap in burden has opened between IBD hospitalizations with and without CDI during the last decade and a half. CDI-related hospitalizations are associated with disproportionately longer lengths of stay, more hospital days, and more charges than hospitalizations without CDI over time. Further work within health systems, hospitals, and practices can help us better understand this enlarging gap to improve clinical care for this vulnerable population.
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