Division of Gastroenterology and Hepatology, University of New Mexico School of Medicine, Albuquerque, NM.
Division of Gastroenterology, University of Arizona College of Medicine.
J Clin Gastroenterol. 2021 Sep 1;55(8):709-715. doi: 10.1097/MCG.0000000000001412.
Clostridioides difficile infection (CDI) is an important cause of inflammatory bowel disease (IBD) exacerbation and is associated with increased risk of hospitalization, colectomy, and mortality. Previous analysis have reported an increasing rate of CDI and associated mortality in IBD patients. We examined the trends in CDI-associated outcomes in hospitalized patients with Crohn's disease (CD) and ulcerative colitis (UC) over the last decade.
We used data from the National Inpatient Sample to identify patients hospitalized with both CDI and IBD from 2006 to 2014. Outcomes included in-hospital mortality, partial/total colectomy, hospital length of stay, and charges. Analysis included univariate and multivariate regression analysis.
Between 2006 and 2014, CDI-related hospitalizations increased in both CD (1.6% to 3.2%; P<0.001) and UC (4.9% to 8.6%; P<0.001). CDI-associated mortality in CD and UC patients decreased from 2.4% to 1.2% (P<0.001) and 11.3% to 9.7% (P<0.001), respectively. CDI-associated colectomy rate increased from 4.3% to 8.8% (P<0.001) in UC but decreased from 4.5% to 2.8% (P<0.001) in CD. In multivariable analysis, compared with 2006, there was a nonsignificant decrease in mortality in 2014 in both CD [adjusted odds ratio (AOR) 0.56, 95% confidence interval (CI) 0.25-1.24] and UC (AOR 0.81, 95% CI 0.61-1.07), but a significant increase in colectomy in 2014 only in UC (AOR 2.12, 95% CI 1.46-3.06).
CDI rates have increased in CD and UC over the last decade. Although there has been a significant increase in colectomies in UC, CDI-associated mortality in CD and UC has not increased over this time.
艰难梭菌感染（CDI）是炎症性肠病（IBD）恶化的一个重要原因，与住院、结肠切除术和死亡率增加有关。先前的分析报告称，IBD 患者的 CDI 发病率和相关死亡率都在增加。我们研究了过去十年中住院克罗恩病（CD）和溃疡性结肠炎（UC）患者中 CDI 相关结局的趋势。
我们使用国家住院患者样本的数据，从 2006 年至 2014 年期间，确定了同时患有 CDI 和 IBD 的住院患者。研究结果包括住院死亡率、部分/全结肠切除术、住院时间和费用。分析包括单变量和多变量回归分析。
在 2006 年至 2014 年期间，CD 患者中（1.6%至 3.2%；P<0.001）和 UC 患者中（4.9%至 8.6%；P<0.001）CDI 相关住院治疗增加。CD 和 UC 患者的 CDI 相关死亡率从 2.4%降至 1.2%（P<0.001）和 11.3%降至 9.7%（P<0.001）。UC 患者的 CDI 相关结肠切除术率从 4.3%升至 8.8%（P<0.001），但 CD 患者的结肠切除术率从 4.5%降至 2.8%（P<0.001）。多变量分析显示，与 2006 年相比，2014 年 CD 患者的死亡率无显著下降（调整后比值比（AOR）0.56，95%置信区间（CI）0.25-1.24）和 UC 患者（AOR 0.81，95% CI 0.61-1.07），但仅在 UC 患者中，2014 年结肠切除术显著增加（AOR 2.12，95% CI 1.46-3.06）。
在过去十年中，CD 和 UC 中的 CDI 发病率有所增加。尽管 UC 中的结肠切除术显著增加，但在此期间，CD 和 UC 中 CDI 相关死亡率并未增加。
