Table 1.
Main short-term outcomes in inflammatory bowel disease patients with Clostridium difficile infection as compared to those with inflammatory bowel disease alone or Clostridium difficile infection alone
| Ref. | Journal and year of publication | Study design and time frame | Outcome |
| Murthy et al[21] Canada | Aliment Pharmacol Ther 2012 | In-patients, Ontario, Canada, 2002-2008 | Increased LOS (11 d vs 6 d, P = 0.0001), similar rate of colectomy (12% vs 9.8%; P = 0.30), and higher mortality rate (3.3% vs 0.38%, P < 0.0001) as compared with UC patients without CDI |
| Navaneethan et al[24] United States | J Crohns Colitis 2012 | Out-/in-patients; 2002-2007 | No significant difference in the colectomy risk within 3 months of index admission between UC patients with CDI and those with UC alone |
| Ananthakrishnan et al[28] United States | Aliment Pharmacol Ther 2012 | In-patients; 1998-2010 | 4.4% colectomy and 15.2% mortality rates |
| Jen et al[17] United Kingdom | Aliment Pharmacol Ther 2011 | Case-control analysis of United Kingdom Hospital Episodes Statistics, out-/in-patients; 2002-2007 | Increased mortality (OR = 6.32), higher risk for surgery (OR = 1.87), and 27.9 d longer LOS than patients with IBD alone |
| Ananthakrishnan et al[18] United States | Inflamm Bowel Dis 2011 | Case-control analysis of NIS database, out-/in-patients; 1998, 2004, 2007 | Increase in colectomy rate 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), and in mortality risk (1998: OR = 2.38, 95%CI: 1.52-3.72) (2007, OR = 3.38, 95%CI: 2.66-4.29) (P = 0.15) |
| Kaneko et al[25] Japan | Clin Res Hepatol Gastroenterol 2011 | Out-/in-patients; 2006-2009 | No association between CDI and colectomy rate in UC patients |
| Kariv et al[20] United States | J Crohns Colitis 2011 | Out-/in- patients with UC; 2000-2006 | No difference in colectomy rates (48% vs 50.9%, P = 0.81) between infected and non-infected UC patients, no mortality in UC patients with or without CDI |
| Jodorkovsky et al[19] United States | Dig Dis Sci 2010 | In-patients; 2004/06-2005/06 | Similar mean LOS for IBD patients with CDI and those without CDI (11.7 d vs 11.0 d; P = 0.70); similar use of cyclosporine therapy (48% vs 47%); higher emergent colectomy rate (23% vs 13.4%, P = 0.17) |
| Bossuyt et al[14] Belgium | J Crohns Colitis 2009 | In-patients; 2000-2008 | LOS shorter as compared to non-IBD patients (15.2 d vs 27.7 d, P = 0.001); one patient with UC+ CDI had a semi-urgent colectomy; no mortality in IBD patients, 2 deaths in non-IBD patients |
| Ricciardi et al[15] United States | Dis Colon Rectum 2009 | Case-control analysis of NIS database, out-/in-patients; 1993-2003 | Increased case fatality in UC+CDI patients but not in those with CD+CDI; operative mortality for UC+CDI patients reached 25.7% |
| Ben-Horin et al[26] Israel and some European countries | Clin Gastroenterol Hepatol 2009 | Multi-center, in-patients; 2000-2008 | Low colectomy rate (6%) in IBD patients with CDI |
| Ananthakrishnan et al[13] United States | Gut 2008 | Case-control analysis of NIS database, out-/in-patients; 2003 | Four-fold higher mortality rate (OR = 4.7, 95%CI: 2.9-7.9) compared with IBD alone and twice higher than in those with CDI alone (OR = 2.21, 95%CI: 1.4-3.4); 3-d longer compared with IBD alone; six-fold greater risk of bowel surgery than those with CDI alone (OR = 6.6, 95%CI: 4.7-9.3); 11406 higher hospital adjusted charges |
| Nguyen et al[16] United States | Am J Gastroenterol 2008 | Case-control analysis of NIS database, out-/in-patients; 1998-2004 | Increased mortality in UC (OR = 3.79, 95%CI: 2.84-5.06) but not in CD patients (OR = 1.66, 95%CI: 0.75-3.66); increased LOS with 65% for CD and 46% for UC, and increased hospital charges compared with non-IBD patients |
| Rodemann et al[12] United States | Clin Gastroenterol Hepatol 2007 | In-patients, 1998-2004 | LOS similar to non-IBD patients |
| Issa et al[11] United States | Clin Gastroenterol Hepatol 2007 | Observational study, out-/in-patients; 2004-2005 | Increased LOS (13 d vs 6 d); the colectomy rate in UC+CDI decreased from 45% in 2004 to 25% in 2005 |
C. difficile: Clostridium difficile; CDI: Clostridium difficile infection; CD: Crohn's disease; IBD: Inflammatory bowel disease; LOS: Length of hospital stay; NIS: National Inpatient Sample; OR: Odds ratio; UC: Ulcerative colitis.