Background
Inflammatory bowel disease (IBD) patients are at an increased risk of Clostridium difficile infection (CDI), but the impact of CDI on disease severity is unclear. The aim of this study was to determine the effect of CDI on long-term disease outcome in a matched cohort of IBD patients.
Methods
Patients who tested positive for infection formed the CDI positive group. We generated a 1:2 propensity matched case to control cohort based on risk factors of CDI in the year prior to infection. Healthcare utilization data (emergency department use, hospitalizations, telephone encounters), medications, labs, disease activity and quality of life (QOL) metrics were compared by CDI status.
Results
A total of 198 patients (66 CDI, 132 matched controls) were included (56.6% female; 60.1% Crohn’s disease, 39.9% ulcerative colitis). In the year of infection, having CDI was significantly associated with more steroid and antibiotic exposure, elevated C-reactive protein or erythrocyte sedimentation rate, low vitamin D, increased disease activity, worse QOL, and increased healthcare utilization (all p<0.01). During the next year after infection, CDI patients continued to have increased exposure to CDI targeted antibiotics (p<0.001) and other antibiotics (p=0.02). They also continued to have more clinic visits (p=0.02), telephone encounters (p=0.001), and increased healthcare financial charges (p=0.001).
Conclusions
CDI in IBD is significantly associated with markers of disease severity, increased healthcare utilization and poor QOL during the year of infection, and a five-fold increase in healthcare charges in the year following infection.