Parth Desai, DO, Chimezie Mbachi, MD, Estefania Flores, MD, Madhu Mathew, MD, Hassam Shah, MD, Zohaib Haque, DO, Vikram Kotwal, MD; John H. Stroger, Jr. Hospital of Cook County, Chicago, IL
Introduction: Clostridioides difficile infection (CDI) is a major cause of nosocomial diarrhea bearing significant morbidity and mortality, causing approximately 35,0000 deaths per year in the United States. Hospitalized patients admitted with inflammatory bowel disease (IBD) have been found to be at greater risk of CDI compared to the general medical population in the US, with approximately 8-fold risk in ulcerative colitis and 2-fold risk in patients with Crohn’s disease. CDI in IBD patients has been implicated in greater rates of colonic perforation, colectomies, length of hospitalization, and increased mortality when compared to patients without C. difficile infection. The evaluation of CDI in IBD patients presents a diagnostic challenge given similar symptoms to IBD flares. We evaluated risk factors for CDI in patients with IBD using the national inpatient sample (NIS) database. Methods: The national inpatient sample (NIS) from 2010-2014 was queried for all patients with Secondary diagnosis of IBD; ICD9 codes 5550, 5551, 5552, 5559, 30520, 30521, 30522, 30523, 30430, 30431, 30432, 30433. CDI was defined by ICD9 code 008.45. IBD patients with primary diagnosis of CDI were directly compared to those without CDI for risk factors and clinical outcomes using univariate and multivariate regression. All analyses were done using STATA v14. Results: There were 315,752 patients with a secondary diagnosis of IBD, out of which 5,945 had a primary diagnosis of C. difficile. When compared to IBD patients with no CDI, CDI patients were older (mean age 53 vs 50, P< 0.001), more likely female (61.3% vs. 56.7%, P< 0.001), and more likely Hispanic (7.4% vs. 5.6%, P< 0.001). They were more likely to have comorbidities including AIDS (0.4 vs. 0.1, P< 0.001), anemia (31.8% vs. 24.1%), liver disease (5.1% vs. 4%), and HTN (41.2% vs. 36.4%, P< 0.001). CDI patients were more likely to die during hospitalization (3.1% vs. 1.6%, P< 0.001). Multivariate regression revealed age > 64 years (aOR 1.49, CI 1.38-1.62, P< 0.001), female gender (aOR 1.21, CI 1.15-1.38, P< 0.001), and Hispanic race (aOR 1.40, CI 1.26-1.56, P< 0.001) to be significant predictors of CDI related admission. Discussion: Risk factors for CDI in patients with IBD include female gender and Hispanic race. This may be due to factors such as health care utilization, gut dysbiosis, and pathological differences in IBD.
Descriptive statistics of patients admitted with a primary discharge diagnosis of IBD
Descriptive statistics of patients admitted with a primary discharge diagnosis of IBD (continued)
Univariate and multivariate logistic regression of risk factors
Disclosures: Parth Desai indicated no relevant financial relationships. Chimezie Mbachi indicated no relevant financial relationships. Estefania Flores indicated no relevant financial relationships. Madhu Mathew indicated no relevant financial relationships. Hassam Shah indicated no relevant financial relationships. Zohaib Haque indicated no relevant financial relationships. Vikram Kotwal indicated no relevant financial relationships.