A0331 - Impact of Inflammatory Bowel Disease in Colonic Resection for Those Hospitalized With Clostridioides difficile Colitis: Insights From the National Inpatient Sample

Introduction: Clostridioides difficile ( C. diff) is a common nosocomial infection with symptoms that range from a mild diarrheal illness to severe, life-threatening colitis. While there is sufficient data demonstrating risk factors, an understanding of factors for developing more severe disease is lacking. Previous literature has shown increased mortality for patients with inflammatory bowel disease (IBD) who become infected with c. difficile, however, a connection between IBD and need for colonic resection has not been established.

Methods: This is a retrospective cohort study using the 2019 National Inpatient Sample (NIS). Inclusion criteria were a principal diagnosis of Clostridioides difficile colitis and age >18. The patients were divided into two groups: those with IBD and those without IBD. IBD was further subdivided into those with ulcerative colitis (UC) and those with Crohn's disease (CD). The primary outcome is rate of colonic resection. Secondary outcomes are: 1) mortality 2) rate of colonoscopy 3) length of stay 4) total hospital charges. Confounders were adjusted for using multivariate regression analysis with the following confounders: sex, income, race, insurance, Charlson comorbidity index, hospital bedsize, location, teaching status, and region.

Results: 76,324 Patients were included in the study, 4.1% with IBD. Both groups predominantly consisted of Caucasian females treated at large, urban teaching hospitals in the Southern United States. 0.22% of the total population studied underwent resection. Compared to the rate of resection in patients without IBD, those with IBD had a 180% increase in odds of colonic resection when compared to patients without IBD while adjusting for confounders. This difference was most notable in the CD subgroup (OR of 4.41). Patients with IBD were also more likely to undergo colonoscopy (OR 3.4) and had hospital charges on average $6,799 more than those without IBD.

Discussion: Those with IBD face an even higher burden of disease than those diagnosed with C. diff without IBD. Both forms of IBD increase the likelihood of the adverse event of colonic resection as a consequence of infection of C. diff while hospitalized, with CD patients having stronger odds of this outcome compared to those diagnosed with UC. With such a strong increase of unfavorable outcomes amongst patients diagnosed with IBD, hospitals should consider implementing stronger measures to prevent nosocomial C. diff amongst those admitted with IBD.