Higher Costs, In-Hospital Mortality in Clostridium difficile with Ulcerative Colitis/Crohn's Disease

Patients with a co-infection of Clostridium difficile and ulcerative colitis or Crohn’s disease have higher rates of in-hospital mortality and health care resource utilization.

Robert Wong, MD, MS

The co-occurrence of Clostridium difficile (C. difficile) and ulcerative colitis (UC) or Crohn’s disease (CD) is associated with higher in-hospital mortality and greater health care costs and resource utilization, according to a study from California researchers published in the European Journal of Gastroenterology & Hepatology.

Considering mortality outcomes and health care costs are generally higher among patients with later disease diagnosis and co-occurring diseases, the findings from this study indicate the importance of early screening strategies for inflammatory bowel disease (IBD) or other gastrointestinal-related disorders in patients with C. difficile.

“IBD is a chronic inflammatory disease of the gastrointestinal tract that is associated with increased risks of infections as a result of both the disease process itself as well as the immunosuppressive therapies we use to treat the disease, [and] hospitalized patients with IBD are at particularly high risk of concurrent infectious complications, especially with C. difficile infection,” lead study author Robert Wong, MD, MS, of the Highland Hospital in Oakland, California, told MD Mag. “Our study demonstrates that infection with C. difficile among hospitalized IBD patients is associated with significantly increased risk of death and significantly increased risk of health care resource utilization.”

The 2007—2013 Nationwide Inpatient Sample (NIS) was used to obtain hospitalization data for US adult patients with ICD-9 code diagnoses of UC, CD, and C. difficile. Investigators stratified health care costs, length of stay, and in-hospital mortality outcomes by UC and CD.

For this study, researchers evaluated predictive factors associated with length of stay, health care costs, and in-hospital mortality in an adjusted multivariate regression analysis which accounted for age, sex, insurance status, hospital characteristics, race-ethnicity, year and C. difficile co-infection.

A total of 224,500 hospitalizations for IBD were found in the NIS, of which 49,871 and 174,629 hospitalizations were attributed to UC and CD, respectively. In patients with UC, the overall prevalence of C. difficile co-infection was approximately 3.41%. Comparatively, the prevalence of C. difficile was 1.22% in patients with CD.

In the adjusted multivariate analysis, patients with a C. difficile co-infection with CD had a significantly longer length of stay compared with mono-infection (coefficient: 5.30, 95% CI: 4.61-5.99, P <.001). Similarly, patients with UC and C. difficile had a significantly longer length of stay compared with patients with C. difficile infection or UC only (coefficient 4.08, 95% CI: 3.54-4.62, P <.001).

Hospital charges (ie, health care costs) were significantly greater among patients with CD and C. difficile (coefficient: $35,720, 95% CI: $30,041-$41,399, P <.001) as well as among patients with UC and C. difficile (coefficient: $26,009, 95% CI: $20,970-$31,046, P <.001). In-hospital mortality was also significantly greater among patients with C. difficile co-infection with UC (odds ratio [OR]: 5.50, 95% CI: 3.83-7.89, P <.001) and CD (OR: 2.74, 95% CI: 1.94-3.87, P <.001).

Patients in this analysis were admitted to US hospitals, limiting the ability to generalize these findings across centers in other regions of the world.

“While the increased risk of death associated with concurrent C. difficile infection among hospitalized IBD patients is not surprising, our study aims to raise greater awareness about the risk and burden of this deadly infection,” Wong added. “We hope that our study encourages clinicians to be more cognizant of this risk and promote early detection and treatment among IBD patients.”


Rezapour M, Galoosian A, Liu B, Bhuket T, Wong RJ. Clostridium difficile co-infection in inflammatory bowel disease is associated with significantly increased in-hospital mortality [published online June 11, 2018]. Eur J Gastroenterol Hepatol. doi: 10.1097/MEG.0000000000001185.