Section of Gastroenterology & Nutrition, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.
Inflamm Bowel Dis. 2013 Apr;19(5):1080-5. doi: 10.1097/MIB.0b013e3182807563.
Children with inflammatory bowel disease (IBD), similar to adults, are at increased risk of acquiring a Clostridium difficile infection (CDI). Our objective was to characterize the health care burden associated with CDI in hospitalized pediatric patients with IBD.
We extracted and analyzed cases with a discharge diagnosis of IBD or CDI from the U.S. Healthcare Cost and Utilization Project Kids' Inpatient Database.
In our primary analysis, we evaluated pediatric cases with a principal diagnosis of IBD or CDI. For the year 2009, we identified 12,610 weighted cases with IBD of which 3.5% had CDI. In children with IBD, CDI was independently associated with lengthier hospital stays (8.0 versus 6.0 days; adjusted regression coefficient, 2.1 days; 95% confidence interval [CI], 1.4-2.8), higher charges ($45,126 versus $34,703; adjusted regression coefficient, $11,506; 95% CI, 6192-16,820), and greater need for parenteral nutrition (15.9% versus 12.1%; adjusted odds ratio, 1.5; 95% CI, 1.1-2.0) and blood transfusion (17.7% versus 9.8%; adjusted odds ratio, 1.8; 95% CI, 1.4-2.4). There were no deaths. We made similar observations in a subanalysis of cases with principal or secondary diagnoses of IBD or CDI. The incidence of CDI in patients with IBD increased between 2000 and 2009 from 21.7 to 28.0 cases per 1000 IBD cases per year (P < 0.001). There was a significant increase in CDI complicating ulcerative colitis (28.1 versus 42.2, P < 0.001) but not for Crohn's disease (18.3 versus 20.3).
CDI represents a significant health care burden in hospitalized children with IBD.
与成年人相似，患有炎症性肠病（IBD）的儿童感染艰难梭菌（CDI）的风险增加。我们的目标是描述与住院患有 IBD 的儿科患者的 CDI 相关的医疗保健负担。
我们从美国医疗保健成本和利用项目儿童住院数据库中提取并分析了以 IBD 或 CDI 为主要诊断的病例。
在我们的主要分析中，我们评估了主要诊断为 IBD 或 CDI 的儿科病例。在 2009 年，我们确定了 12610 例加权 IBD 病例，其中 3.5%患有 CDI。在患有 IBD 的儿童中，CDI 与住院时间延长独立相关（8.0 天与 6.0 天；调整后的回归系数为 2.1 天；95%置信区间[CI]为 1.4-2.8），费用更高（45126 美元与 34703 美元；调整后的回归系数为 11506 美元；95%CI 为 6192-16820 美元），需要更多的肠外营养（15.9%与 12.1%；调整后的优势比为 1.5；95%CI 为 1.1-2.0）和输血（17.7%与 9.8%；调整后的优势比为 1.8；95%CI 为 1.4-2.4）。没有死亡。在以 IBD 的主要或次要诊断为病例的子分析中，我们也有类似的观察结果。2000 年至 2009 年期间，IBD 患者中 CDI 的发病率从每年每 1000 例 IBD 病例 21.7 例增加到 28.0 例（P < 0.001）。溃疡性结肠炎并发 CDI 的发生率显著增加（28.1 例与 42.2 例，P < 0.001），但克罗恩病并无增加（18.3 例与 20.3 例）。
CDI 代表住院患有 IBD 的儿童的重大医疗保健负担。
