P646 Outcome of Clostridium difficile Infection in Inflammatory Bowel Disease Patients Hospitalized due to an Exacerbation
N. Maharshak, I. Barzilay, O. Davidov, K. Hod, I. Dotan*
Tel Aviv Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Department of Gastroenterology and Liver Diseases, Tel Aviv, Israel
Inflammatory bowel disease (IBD) is considered a risk factor for Clostridium difficile infection (CDI). Once infected, IBD patients are thought to be at increased risk for complications and mortality. However, most studies evaluated outcomes in hospitalized IBD patients including those not initially hospitalized for IBD exacerbation. We aimed to find the rate and clinical implications of CDI in IBD patients who were hospitalized due to IBD exacerbation in order to clarify whether these patients should be more aggressively treated and followed for CDI as has been previously suggested.
Clinical data were retrospectively retrieved from electronic patient files of all IBD patients (according to the ICD-9 codes) hospitalized in a tertiary referral center (the Tel Aviv Medical Center, Israel) between 1/7/2008 to 31/7/2013. Inclusion criteria included hospitalization due to diarrhea and being tested for CDI. Patients that were post total colectomy were excluded from the study.
A total of 383 IBD patients [ulcerative colitis (UC):151; Crohn's disease (CD):225, and IBD-U:7] were tested for CDI during the study period. CDI was detected in 28 (7.3%) patients (7.3% UC; 7.6% CD). The mean age of patients with or without CDI was comparable (46 ± 21 vs. 44 ± 20 years, respectively). Patients with CDI were more frequently hospitalized during the 2 months prior to CDI (71% vs 29%, P<0.05), they were more likely to be treated by systemic steroids (50% vs 24%, P<0.05) and by proton pump inhibitors (54% vs 21%, P<0.05).
Patients with or without CDI had similar mean hospitalization duration (7.1 days), and there was no significant difference in mortality and in the number of subsequent hospitalizations during the year following CDI was noticed.
The rate of CDI in patients hospitalized due to IBD exacerbation is 7.3%, higher than the reported CDI rate of the general population. However, CDI may not impact patients' prognosis as previously thought.