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Frequency and Risk Factors of Clostridium difficile Infection in Hospitalized Patients With Pouchitis: A
Gaurav Kistangari1, Rocio Lopez, Bo Shen
1*Department of Hospital Medicine, Medicine Institute, The Cleveland Clinic Foundation, Cleveland, Ohio; †Department of Quantitative Health Sciences, Lerner Research Institute, The Cleveland Clinic Foundation, Cleveland, Ohio; and ‡Center for Inflammatory Bowel Diseases, The Cleveland Clinic Foundation, Cleveland, Ohio.
Insights
Clostridium difficile infection (CDI) is rare in patients with ileal pouchitis due to familial adenomatous polyposis (FAP). Nonalcoholic fatty liver disease, obesity, and sleep apnea increase CDI risk in inflammatory bowel disease (IBD) patients with pouchitis.
Area of Science:
- Gastroenterology
- Infectious Diseases
- Surgical Outcomes
Background:
- Clostridium difficile infection (CDI) is a growing concern in patients with ileal pouches following proctocolectomy.
- Pouchitis, inflammation of the ileal pouch, presents a specific context for evaluating CDI.
- Understanding CDI prevalence and risk factors in this population is crucial for patient management.
Purpose of the Study:
- To determine the frequency of CDI in patients diagnosed with pouchitis.
- To identify risk factors associated with CDI in patients with pouchitis, particularly those with underlying inflammatory bowel disease (IBD).
Main Methods:
- Utilized the National Inpatient Sample database (2010-2012) to identify patients with pouchitis.
- Included patients with underlying inflammatory bowel disease (IBD) or familial adenomatous polyposis (FAP).
- Analyzed concomitant diagnoses for CDI and performed multivariable analysis for risk factors in IBD patients.
Main Results:
- A total of 3566 pouchitis patients were analyzed; 2.5% had CDI.
- CDI occurred in 2.6% of pouchitis patients with IBD, but none with FAP.
- Nonalcoholic fatty liver disease, obesity, and obstructive sleep apnea were significant risk factors for CDI in IBD patients with pouchitis.
Conclusions:
- CDI in ileal pouchitis appears limited to patients with underlying IBD, being rare in FAP patients.
- Nonalcoholic fatty liver disease, obesity, and obstructive sleep apnea are identified as key risk factors for CDI in IBD patients with pouchitis.
Background:
Clostridium difficile infection (CDI) in patients with the ileal pouch after proctocolectomy has been increasingly recognized. We sought to evaluate the frequency and risk factors of CDI in patients with the primary or secondary discharge diagnosis of pouchitis in the United States.
Methods:
We reviewed the National Inpatient Sample of the Healthcare Cost and Utilization Project and identified patients admitted for pouchitis with underlying inflammatory bowel disease (IBD) or familial adenomatous polyposis (FAP), between 2010 and 2012. Cases with CDI were identified based on a concomitant primary or secondary discharge diagnosis for CDI. The frequency of CDI was estimated in patients with underlying IBD and FAP. Multivariable analysis was conducted to study the risk factors associated with CDI in those with pouchitis with underlying IBD.
Results:
A total of 3566 eligible patients with pouchitis were identified during the study period. Eighty-nine patients (2.5%) had CDI as a concomitant primary or secondary discharge diagnosis. CDI was identified in 2.6% (99.9% confidence interval [CI], 1.3-3.8) of pouchitis patients with underling IBD. None of the patients with pouchitis with underlying FAP were found to have CDI during the study period. Among pouchitis patients with underlying IBD, the presence of nonalcoholic fatty liver disease (odds ratio = 5.4; 95% CI, 1.5-19.9), obesity (odds ratio = 5.5; 95% CI, 1.4-21.4), or obstructive sleep apnea (odds ratio = 10.3; CI, 2.0-53.7) was associated with an increased risk of CDI.
Conclusions:
It seems that CDI was limited to pouchitis with underlying IBD and rare in those with underlying FAP. Patients with nonalcoholic fatty liver disease, obesity, and obstructive sleep apnea are at an increased risk of C. difficile pouchitis among patients with IBD.
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