Colectomy Rates Are Increasing Among Inpatients With Concomitant Ulcerative Colitis and Clostridioides difficile

Area of Science:

• Gastroenterology
• Infectious Diseases
• Epidemiology

Background:

• Clostridioides difficile infection (CDI) exacerbates inflammatory bowel disease (IBD), increasing hospitalization, colectomy, and mortality risks.
• Previous studies indicate rising CDI rates and mortality in IBD patients.
• This study investigates trends in CDI-associated outcomes among hospitalized Crohn's disease (CD) and ulcerative colitis (UC) patients over a decade.

Purpose of the Study:

• To analyze trends in Clostridioides difficile infection (CDI) associated outcomes in hospitalized patients with inflammatory bowel disease (IBD).
• To examine changes in CDI-associated mortality, colectomy rates, length of stay, and charges in Crohn's disease (CD) and ulcerative colitis (UC) patients from 2006 to 2014.

Main Methods:

• Utilized the National Inpatient Sample database to identify hospitalized patients with concurrent CDI and IBD (CD or UC) between 2006 and 2014.
• Analyzed in-hospital mortality, partial/total colectomy rates, hospital length of stay, and hospital charges.
• Employed univariate and multivariate regression analyses to assess trends and associated factors.

Main Results:

• CDI-related hospitalizations increased significantly in both CD (1.6% to 3.2%) and UC (4.9% to 8.6%) patients.
• CDI-associated mortality decreased in CD (2.4% to 1.2%) and UC (11.3% to 9.7%) patients.
• Colectomy rates increased in UC (4.3% to 8.8%) but decreased in CD (4.5% to 2.8%). Multivariate analysis showed a significant increase in colectomy for UC (AOR 2.12) but not for CD.

Conclusions:

• CDI incidence has risen in both CD and UC patients over the past decade.
• Despite increased colectomy rates in UC patients, CDI-associated mortality has not significantly increased in either CD or UC patients.
• These findings highlight evolving trends in CDI management and outcomes within the IBD population.