TOPLINE:

Hospitalized patients with inflammatory bowel disease (IBD) who developed Clostridioides difficile infection (CDI) experienced worse clinical outcomes, including higher rates of mortality, increased rates of septic shock, and a greater requirement for mechanical ventilation. 

METHODOLOGY:

• IBD is characterized by chronic intestinal inflammation and microbial dysbiosis, which reduce microbial diversity and impair colonization resistance to CDI; frequent use of antibiotics, immunosuppressants, and corticosteroids in IBD further disrupts the gut microbiome and promotes these infections.
• Researchers conducted a retrospective cohort study using a national database in the US to assess trends and clinical outcomes associated with CDI among patients hospitalized with IBD from 2012 to 2021.
• Admissions were stratified by CDI status, yielding two groups — IBD with CDI (CDI recorded as a primary or secondary diagnosis during the same hospitalization) and IBD without CDI. Patients with IBD and CDI, including those with ulcerative colitis (UC) or Crohn’s disease, were analyzed further.
• Primary outcomes were in‑hospital mortality, use of mechanical ventilation, and incidence of septic shock; secondary outcomes included length of hospital stay, total hospital charges, and frequency for blood transfusions.

TAKEAWAY:

• Among 4,193,564 hospitalized patients (mean age, 61.03 years; 55.86% women), 534,190 (12.7%) were diagnosed with CDI.
• Patients with vs without CDI had higher rates of in-hospital mortality (3.61% vs 2.03%), more septic shock (5.4% vs 4.0%), and a greater need for mechanical ventilation (4.2% vs 2.8%; P < .001 for all).
• Additionally, patients with vs without CDI had longer hospital stays (mean, 5.93 vs 5.87 days), higher total hospital charges (median, $34,911 vs $29,660), and a higher frequency of blood transfusions (9.0% vs 7.0%; P < .001 for all).
• UC was more prevalent in the CDI vs non‑CDI group (30.3% vs 25.0%; P < .001). Among patients with CDI, UC was independently associated with higher odds of septic shock (odds ratio [OR], 1.09) and venous thromboembolism (OR, 1.06) but lower odds of mortality (OR, 0.81; P < .05 for all).

IN PRACTICE:

“These findings highlight the importance of early recognition, preventive strategies, and tailored management approaches for CDI in IBD patients,” the authors wrote.

SOURCE:

This study was led by Shivangini Duggal, MD, Department of Internal Medicine, Texas Tech University Health Sciences Center El Paso. It was published online in the Journal of Clinical Gastroenterology.

LIMITATIONS:

The use of standardized diagnostic codes may have led to misclassification. The database lacked clinical details on disease activity, laboratory results, medications, and timing of CDI relative to admission. The observational design limited causal inference.

DISCLOSURES:

No funding source was mentioned explicitly. The authors declared having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.