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Epidemiology of Clostridium difficile Colitis in Hospitalized Patients with Inflammatory Bowel Diseases

Ricciardi, Rocco M.D., M.P.H.1,2,3; Ogilvie, James W. Jr. M.D.3; Roberts, Patricia L. M.D.1; Marcello, Peter W. M.D.1; Concannon, Thomas W. Ph.D.2; Baxter, Nancy N. M.D., Ph.D.4

Diseases of the Colon & Rectum: January 2009 - Volume 52 - Issue 1 - p 40-45
doi: 10.1007/DCR.0b013e31819733fd
Original Contributions

PURPOSE: A notable increase in-hospital admissions for Clostridium difficile colitis has occurred in the United States. In this paper we evaluate changes in the epidemiology of Clostridium difficile colitis in a subset of hospitalized patients with inflammatory bowel diseases.

METHODS: A retrospective cohort analysis was conducted for all inflammatory bowel disease patients with Clostridium difficile colitis in the Nationwide Inpatient Sample, a 20 percent stratified random sample of national hospital discharge abstracts from 1993 through 2003. Using standard diagnostic codes, we identified yearly admissions for Clostridium difficile, other bacterial infections, and parasitic infections in inflammatory bowel disease patients. Next, we calculated prevalence, case fatality, and operative mortality for inflammatory bowel disease patients diagnosed with Clostridium difficile.

RESULTS: We found that the prevalence of Clostridium difficile rose significantly in patients with ulcerative colitis and in those Crohn's disease patients with some component of large bowel involvement but not in patients with Crohn's disease limited to the small bowel alone. During the study period, case fatality also rose significantly in patients with ulcerative colitis and Clostridium difficile but not in patients with Crohn's disease and Clostridium difficile. Operative mortality for ulcerative colitis patients with Clostridium difficile reached 25.7 percent.

CONCLUSIONS: The prevalence and case fatality of patients with inflammatory bowel disease and Clostridium difficile rose significantly during the study period. Changes in Clostridium difficile epidemiology were particularly noteworthy for those patients with ulcerative colitis, who experienced elevated rates of hospitalization and case fatality.

1 Department of Colorectal Surgery, Lahey Clinic, Burlington, Massachusetts

2 Institute for Clinical Research and Health Policy Studies, Tufts University, Boston, Massachusetts

3 Department of Surgery, University of Minnesota, Minneapolis, Minnesota

4 Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada

Read at the meeting of The American Society of Colon and Rectal Surgeons, St. Louis, Missouri, June 2 to 6, 2007.

Dr. Ricciardi was supported by the University of Minnesota's Academic Health Center Clinical Research Grant.

Reprints are not available.

Address of correspondence: Rocco Ricciardi, M.D., M.P.H., Department of Colon and Rectal Surgery, Lahey Clinic, Tufts University Medical School, Institute for Clinical Research and Health Policy Studies, 41 Mall Road, Burlington, Massachusetts 01805. E-mail:

© The ASCRS 2009