National Survey of Prevalence and Impact of Clostridium difficile Infection
National Survey of Prevalence and Impact of Clostridium difficile Infection
Background: We sought to determine nationwide, population-based trends in rates of Clostridium difficile (C. difficile) infection among hospitalized inflammatory bowel disease (IBD) patients in the United States, and to determine its mortality and economic impact.
Methods: We analyzed discharge records from the Nationwide Inpatient Sample, and used the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes to identify Crohn's disease (CD) and ulcerative colitis (UC) cases, and cases of C. difficile infection between 1998 and 2004. Temporal patterns of C. difficile incidence in IBD patients were compared to non-IBD gastroenterology patients and all-hospitalized patients. The impact of C. difficile on in-hospital mortality and resource utilization was quantified using multiple regression analysis.
Results: The prevalence of C. difficile among UC patients (37.3 per 1,000, 95% confidence interval [CI] 34.0–40.7 per 1,000) was higher than that among CD patients (10.9 per 1,000, 95% CI 9.9–12.0 per 1,000), non-IBD gastrointestinal (GI) patients (4.8 per 1,000, 95% CI 4.6–5.0 per 1,000), and general medical patients (4.5 per 1,000, 95% CI 4.2–4.7 per 1,000). C. difficile incidence nearly doubled among UC patients (26.6 per 1,000 to 51.2 per 1,000) over 7 yr. After adjustment for confounders, C. difficile infection was associated with greater mortality among patients with UC (odds ratio [OR] 3.79, 95% CI 2.84–5.06), but not CD (OR 1.66, 95% CI 0.75–3.66). C. difficile was also associated with 65% and 46% longer lengths of stay, which correlated with 63% and 46% higher average hospital charges, for CD and UC patients, respectively.
Conclusions:C. difficile infection is a growing public health issue among hospitalized IBD patients, especially those with UC, and is associated with higher mortality and resource utilization, prompting the need for better preventative measures and early detection.
Infectious diarrhea associated with Clostridium difficile (C. difficile) has emerged as a major public health concern over the last decade. The incidence of C. difficile infection among inpatients in U.S. acute-care hospitals has increased substantially in the last decade, only to be compounded by the advent of newer virulent strains in North America and increasing case fatality rates. Individuals who are particularly at risk include the elderly, those with prolonged hospitalizations, recent antibiotic use, and systemic comorbidities, and those who are immunocompromised.
The inflammatory bowel diseases (IBD), comprising Crohn's disease (CD) and ulcerative colitis (UC), are chronically relapsing conditions that frequently require hospitalization. Many of these patients are on immunosuppressive medications that may confer additional risk of C. difficile infection. Two recent single-center, retrospective studies reported rising rates of C. difficile infection among IBD patients, which exceeded those of the general, inpatient population. These findings underscored the potential contributions of C. difficile toward IBD-related morbidity.
However, rising rates of C. difficile infection in the IBD population have been reported only in tertiary specialty centers, and it is unclear whether data from these highly selected referral populations accurately reflected time trends in unselected IBD populations. In order to compare temporal patterns of C. difficile infection between hospitalized IBD patients and non-IBD patients at national and population-based levels, we conducted a survey of the Nationwide Inpatient Sample (NIS), the largest database of short-stay hospital discharges in the United States. Using these nationwide data, we also sought to explore the impact of C. difficile infection on hospital outcomes and resource utilization, and its potential demographic risk factors.
Background: We sought to determine nationwide, population-based trends in rates of Clostridium difficile (C. difficile) infection among hospitalized inflammatory bowel disease (IBD) patients in the United States, and to determine its mortality and economic impact.
Methods: We analyzed discharge records from the Nationwide Inpatient Sample, and used the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes to identify Crohn's disease (CD) and ulcerative colitis (UC) cases, and cases of C. difficile infection between 1998 and 2004. Temporal patterns of C. difficile incidence in IBD patients were compared to non-IBD gastroenterology patients and all-hospitalized patients. The impact of C. difficile on in-hospital mortality and resource utilization was quantified using multiple regression analysis.
Results: The prevalence of C. difficile among UC patients (37.3 per 1,000, 95% confidence interval [CI] 34.0–40.7 per 1,000) was higher than that among CD patients (10.9 per 1,000, 95% CI 9.9–12.0 per 1,000), non-IBD gastrointestinal (GI) patients (4.8 per 1,000, 95% CI 4.6–5.0 per 1,000), and general medical patients (4.5 per 1,000, 95% CI 4.2–4.7 per 1,000). C. difficile incidence nearly doubled among UC patients (26.6 per 1,000 to 51.2 per 1,000) over 7 yr. After adjustment for confounders, C. difficile infection was associated with greater mortality among patients with UC (odds ratio [OR] 3.79, 95% CI 2.84–5.06), but not CD (OR 1.66, 95% CI 0.75–3.66). C. difficile was also associated with 65% and 46% longer lengths of stay, which correlated with 63% and 46% higher average hospital charges, for CD and UC patients, respectively.
Conclusions:C. difficile infection is a growing public health issue among hospitalized IBD patients, especially those with UC, and is associated with higher mortality and resource utilization, prompting the need for better preventative measures and early detection.
Infectious diarrhea associated with Clostridium difficile (C. difficile) has emerged as a major public health concern over the last decade. The incidence of C. difficile infection among inpatients in U.S. acute-care hospitals has increased substantially in the last decade, only to be compounded by the advent of newer virulent strains in North America and increasing case fatality rates. Individuals who are particularly at risk include the elderly, those with prolonged hospitalizations, recent antibiotic use, and systemic comorbidities, and those who are immunocompromised.
The inflammatory bowel diseases (IBD), comprising Crohn's disease (CD) and ulcerative colitis (UC), are chronically relapsing conditions that frequently require hospitalization. Many of these patients are on immunosuppressive medications that may confer additional risk of C. difficile infection. Two recent single-center, retrospective studies reported rising rates of C. difficile infection among IBD patients, which exceeded those of the general, inpatient population. These findings underscored the potential contributions of C. difficile toward IBD-related morbidity.
However, rising rates of C. difficile infection in the IBD population have been reported only in tertiary specialty centers, and it is unclear whether data from these highly selected referral populations accurately reflected time trends in unselected IBD populations. In order to compare temporal patterns of C. difficile infection between hospitalized IBD patients and non-IBD patients at national and population-based levels, we conducted a survey of the Nationwide Inpatient Sample (NIS), the largest database of short-stay hospital discharges in the United States. Using these nationwide data, we also sought to explore the impact of C. difficile infection on hospital outcomes and resource utilization, and its potential demographic risk factors.
