90-Day Specific Readmission for Clostridium difficile Infection After Hospitalization With an Inflammatory Bowel Disease Flare: Outcomes and Risk Factors

Abstract

Background Patients with inflammatory bowel disease (IBD) have an increased risk for Clostridium difficile infection (CDI) and carry significantly higher morbidities and mortality than those without IBD. We aimed to investigate disease-specific readmission rates and independent risk factors for CDI within 90 days of an index hospitalization for an IBD flare. Methods The Nationwide Readmission Database was queried for the year 2016. We collected data on hospital readmissions of 50,799 adults who were hospitalized for urgent IBD flare and discharged. The primary outcome was disease-specific readmission rate for CDI within 90 days of discharge. The secondary outcomes were readmission rate of colonoscopic procedures, morbidities (including mechanical ventilation and shock), and hospital economic burden. The risk factors for readmission were identified using Cox regression analysis. Results The 90-day specific readmission rate was 0.1% (N = 477). A total of 3,005 days were associated with readmission, and the total health care in-hospital economic burden of readmission was $19.1 million (in charges) and $4.79 million (in costs). Independent predictors during index admission for readmission were mechanical ventilation for >24 hours (hazard ratio [HR], 6.62, 95% confidence interval [CI], 0.80-54.57); history of previous CDI (HR, 5.48; 95% CI, 3.66-8.19); HIV-positive status (HR, 4.60; 95% CI, 1.03-20.50); alcohol abuse disorders (HR, 2.06; 95% CI, 1.15-3.70); Parkinson’s disease (HR, 4.68; 95% CI, 1.65-13.31); index admission for noncomplicated ulcerative colitis (HR, 4.72; 95% CI, 2.99-7.45]-), complicated ulcerative colitis (HR, 4.49; 95% CI, 2.80- 7.18), or noncomplicated Crohn disease (HR, 2.54; 95% CI, 2.80-4.04); and hospital length of stay (HR, 1.01; 95% CI, 1.01-1.02). Conclusions The 90-day CDI-specific readmission rate after the index admission of IBD flares was 0.1%. We found risk factors for CDI-associated readmissions such as history of Parkinson’s disease, prior CDI, HIV-positive status, and alcohol abuse disorder. Finally, our study also revealed a high health care cost, charges, and burden.

The interplay of Clostridioides difficile infection and inflammatory bowel disease

“…Patients with IBD who have CDI have worse long-term clinical outcomes (including UC-related hospitalizations, failure of immunosuppression, emergency visits, and the need for colectomy) compared with CDI negative patients at 1 year after the initial admission. 6 , 8 , 12 , 21 – 23 …”

“…Patients with IBD who have CDI have worse long-term clinical outcomes (including UC-related hospitalizations, failure of immunosuppression, emergency visits, and the need for colectomy) compared with CDI negative patients at 1 year after the initial admission. 6,8,12,[21][22][23] Data from the NIS from 1993 to 2003 for all IBD patients with CDI demonstrated that the case fatality for UC patients with C. difficile was 8.5% and was especially high (⩾25%) in patients who underwent routine intestinal surgery. 24 Patients with both CDI and IBD have a longer hospital length of stay by 3 days than those with IBD but without CDI.…”

Clinical Features of Crohn’s Disease Stratified by Age at Diagnosis According to Montreal Classification

“… 19 We found that CD patients in group A2 were more likely to have CDI than group A3, the occurrence rates were 17.05% and 6.67%, respectively. CDI could increase the health care burden and 90-day CDI-specific readmission rate of IBD, 20 and it could increase the risk of surgery by depleting the beneficial fecal microbiome and methionine biosynthesis. 21 …”

A Systematic Literature Review on Risk Factors for and Timing of Clostridioides difficile Infection in the United States

“…However, in specific patient populations, age was often not related to CDI risk. For example, age was a significant risk factor in only two of four studies in patients receiving solid organ transplants [28,[39][40][41], one of three studies in patients with bowel disease [42][43][44], and one of four studies in patients with cancer [45][46][47][48].…”