Temporal Trends in Disease Outcomes Related to Clostridium Difficile Infection in Patients with Inflammatory Bowel Disease
Temporal Trends in Disease Outcomes Related to Clostridium Difficile Infection in Patients with Inflammatory Bowel Disease
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DOI：
10.1002/ibd.21457
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发表时间：
2011-04-01
影响因子：
4.9
通讯作者：
Binion, David G.
中科院分区：
文献类型：
--
作者：
Ananthakrishnan, Ashwin N.;McGinley, Emily L.;Binion, David G.
背景资料：艰难梭菌已成为炎症性肠病（IBD）患者的重要病原体，并与发病率和死亡率增加相关。没有研究检查C的严重程度的时间变化。方法：使用来自全国住院患者样本的数据，我们确定了1998年、2004年和2007年期间所有与IBD相关的住院，并检查了与C.很难我们比较了C。在这些时间点期间，对难治性IBD队列进行了研究，并检查了相对于非C.结果：在1998年、2004年和2007年期间，全国范围内约1.4%、2.3%和2.9%的IBD住院患者并发CDI（P < 0.001）。C. 1998年至2007年，艰难IBD队列的结肠切除率从5.9%增加至7.2%（P = 0.052），结肠切除率从3.8%增加至4.5%，无显著性差异。与非C相比。与艰难梭菌IBD对照组相比，与C. 1998年艰难（比值比[OR] 2.38，95%置信区间[CI]：1.52-3.72）至2007年（OR 3.38，95% CI：2.66-4.29）（P = 0.15）与1998年相比，全结肠切除术的几率显著增加（OR 1.39，95%CI：0.81-2.37）至2007年（OR 2.51，95%CI：1.90-3.34）（P = 0.03）。与C.在1998年至2007年期间，住院IBD患者中的艰难梭菌感染增加。
Background: Clostridium difficile has emerged as an important pathogen in patients with inflammatory bowel disease (IBD) and is associated with increased morbidity and mortality. No studies have examined the temporal change in severity of C. difficile infection (CDI) complicating IBD.Methods: Using data from the Nationwide Inpatient Sample, we identified all IBD-related hospitalizations during the years 1998, 2004, and 2007 and examined hospitalizations with a coexisting diagnosis of C. difficile. We compared the absolute outcomes of in-hospital mortality and colectomy in the C. difficile-IBD cohort during these timepoints, and also examined these outcomes relative to non-C. difficile IBD controls during each corresponding year.Results: During 1998, 2004, and 2007, approximately 1.4%, 2.3%, and 2.9% of all IBD hospitalizations nationwide were complicated by CDI (P < 0.001). The absolute mortality in the C. difficile-IBD cohort increased from 5.9%-7.2% (P = 0.052) with a nonsignificant increase in colectomy rate from 3.8%-4.5% between 1998 and 2007. Compared to non-C. difficile IBD controls, there was an increase in the relative mortality risk associated with C. difficile from 1998 (odds ratio [OR] 2.38, 95% confidence interval [CI]: 1.52-3.72) to 2007 (OR 3.38, 95% CI: 2.66-4.29) (P = 0.15) with a significant increase in total colectomy odds from 1998 (OR 1.39, 95% CI: 0.81-2.37) to 2007 (OR 2.51, 95% CI: 1.90-3.34) (P = 0.03).Conclusion: There has been a temporal increase nationwide in CDI complicating IBD hospitalizations. The excess morbidity associated with C. difficile infection in hospitalized IBD patients has increased between 1998 and 2007.