PURPOSE: A notable increase in-hospital admissions for Clostridium difficile colitis has occurred in the United States. In this paper we evaluate changes in the epidemiology of Clostridium difficile colitis in a subset of hospitalized patients with inflammatory bowel diseases. METHODS: A retrospective cohort analysis was conducted for all inflammatory bowel disease patients with Clostridium difficile colitis in the Nationwide Inpatient Sample, a 20 percent stratified random sample of national hospital discharge abstracts from 1993 through 2003. Using standard diagnostic codes, we identified yearly admissions for Clostridium difficile, other bacterial infections, and parasitic infections in inflammatory bowel disease patients. Next, we calculated prevalence, case fatality, and operative mortality for inflammatory bowel disease patients diagnosed with Clostridium difficile. RESULTS: We found that the prevalence of Clostridium difficile rose significantly in patients with ulcerative colitis and in those Crohn's disease patients with some component of large bowel involvement but not in patients with Crohn's disease limited to the small bowel alone. During the study period, case fatality also rose significantly in patients with ulcerative colitis and Clostridium difficile but not in patients with Crohn's disease and Clostridium difficile. Operative mortality for ulcerative colitis patients with Clostridium difficile reached 25.7 percent. CONCLUSIONS: The prevalence and case fatality of patients with inflammatory bowel disease and Clostridium difficile rose significantly during the study period. Changes in Clostridium difficile epidemiology were particularly noteworthy for those patients with ulcerative colitis, who experienced elevated rates of hospitalization and case fatality.
PURPOSE: A notable increase in-hospital admissions for Clostridium difficilecolitis has occurred in the United States. In this paper we evaluate changes in the epidemiology of Clostridium difficilecolitis in a subset of hospitalized patients with inflammatory bowel diseases. METHODS: A retrospective cohort analysis was conducted for all inflammatory bowel diseasepatients with Clostridium difficilecolitis in the Nationwide Inpatient Sample, a 20 percent stratified random sample of national hospital discharge abstracts from 1993 through 2003. Using standard diagnostic codes, we identified yearly admissions for Clostridium difficile, other bacterial infections, and parasitic infections in inflammatory bowel diseasepatients. Next, we calculated prevalence, case fatality, and operative mortality for inflammatory bowel diseasepatients diagnosed with Clostridium difficile. RESULTS: We found that the prevalence of Clostridium difficile rose significantly in patients with ulcerative colitis and in those Crohn's diseasepatients with some component of large bowel involvement but not in patients with Crohn's disease limited to the small bowel alone. During the study period, case fatality also rose significantly in patients with ulcerative colitis and Clostridium difficile but not in patients with Crohn's disease and Clostridium difficile. Operative mortality for ulcerative colitispatients with Clostridium difficile reached 25.7 percent. CONCLUSIONS: The prevalence and case fatality of patients with inflammatory bowel disease and Clostridium difficile rose significantly during the study period. Changes in Clostridium difficile epidemiology were particularly noteworthy for those patients with ulcerative colitis, who experienced elevated rates of hospitalization and case fatality.
Authors: María E Negrón; Herman W Barkema; Kevin Rioux; Jeroen De Buck; Sylvia Checkley; Marie-Claude Proulx; Alexandra Frolkis; Paul L Beck; Levinus A Dieleman; Remo Panaccione; Subrata Ghosh; Gilaad G Kaplan Journal: Can J Gastroenterol Hepatol Date: 2014 Jul-Aug