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Health Care Burden of Clostridium difficile Infection in Hospitalized Children with Inflammatory Bowel Disease

Pant, Chaitanya MD*; Anderson, Michael P. PhD; Deshpande, Abhishek MD, PhD; Altaf, Muhammad A. MD*; Grunow, John E. MD*; Atreja, Ashish MD, MPH§; Sferra, Thomas J. MD

doi: 10.1097/MIB.0b013e3182807563
Original clinical Articles

Background: Children with inflammatory bowel disease (IBD), similar to adults, are at increased risk of acquiring a Clostridium difficile infection (CDI). Our objective was to characterize the health care burden associated with CDI in hospitalized pediatric patients with IBD.

Methods: We extracted and analyzed cases with a discharge diagnosis of IBD or CDI from the U.S. Healthcare Cost and Utilization Project Kids' Inpatient Database.

Results: In our primary analysis, we evaluated pediatric cases with a principal diagnosis of IBD or CDI. For the year 2009, we identified 12,610 weighted cases with IBD of which 3.5% had CDI. In children with IBD, CDI was independently associated with lengthier hospital stays (8.0 versus 6.0 days; adjusted regression coefficient, 2.1 days; 95% confidence interval [CI], 1.4–2.8), higher charges ($45,126 versus $34,703; adjusted regression coefficient, $11,506; 95% CI, 6192–16,820), and greater need for parenteral nutrition (15.9% versus 12.1%; adjusted odds ratio, 1.5; 95% CI, 1.1–2.0) and blood transfusion (17.7% versus 9.8%; adjusted odds ratio, 1.8; 95% CI, 1.4–2.4). There were no deaths. We made similar observations in a subanalysis of cases with principal or secondary diagnoses of IBD or CDI. The incidence of CDI in patients with IBD increased between 2000 and 2009 from 21.7 to 28.0 cases per 1000 IBD cases per year (P < 0.001). There was a significant increase in CDI complicating ulcerative colitis (28.1 versus 42.2, P < 0.001) but not for Crohn's disease (18.3 versus 20.3).

Conclusions: CDI represents a significant health care burden in hospitalized children with IBD.

Article first published online 8 March 2013

*Section of Gastroenterology & Nutrition, Department of Pediatrics;

Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma;

Department of Medicine, Case Western Reserve School of Medicine;

§Department of Gastroenterology and Hepatology, Cleveland Clinic; and

Division of Gastroenterology & Nutrition, Department of Pediatrics, Case Western Reserve University School of Medicine, University Hospitals Rainbow Babies & Children's Hospital, Cleveland, Ohio.

Reprints: Thomas J. Sferra, MD, Division of Gastroenterology & Nutrition, Department of Pediatrics, UH Rainbow Babies & Children's Hospital, 11100 Euclid Avenue, Suite 737, MS RBC 6004, Cleveland, OH 44106 (e-mail:

The authors have no conflicts of interest to disclose.

Received July 10, 2012

Accepted August 06, 2012

© Crohn's & Colitis Foundation of America, Inc.
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