P0691 - In-Hospital Mortality, Outcomes, and Cost Analysis of Hospitalized C. difficile Patients With Inflammatory Bowel Disease: A Nationwide Sample Study

Onyinye Ugonabo, MD¹, Rajan Lamichhane, PhD, MSc², Khwaja S. Haq, MD³, Pramod Pantangi, MD², Mohamed Hammad, MD², Shima Ghavimi, MD^4
1Marshall University Joan C. Edwards School of Medicine, Huntington, WV; ²Marshall University, Huntington, WV; ³Wellstar Spalding Regional Medical Center, Griffin, GA; ⁴Cedar Valley Digestive Health Center, Cedar Falls, IA

Introduction: Clostridium difficile (C. diff) is the leading cause of nosocomial diarrhea and has been shown to impact about 13 in every 1000 hospitalized patients. The occurrence of C. diff and Inflammatory bowel disease (IBD) have been linked to disruption of the gut microbiota (dysbiosis) which may explain the parallel rise of C. diff infection in IBD patients. Our study aimed to analyze the cost burden and clinical outcomes of hospitalized IBD patients with C. diff infections.

Methods: 240,550 adults hospitalized with Crohn’s disease or Ulcerative colitis were analyzed using the NIS data from 2016-2019. Patients were classified into a group with C. diff and a group without C. diff and variables like Age, gender, race, diabetes mellitus, nicotine use, anemia, end-stage renal disease (ESRD), thrombocytopenia, albumin abnormality, peritoneal abscess, toxic megacolon, gastrointestinal bleed, vesicovaginal fistula, anorectal fistula, vesicointestinal fistula, mortality, and hospitalization cost were analyzed using the two-sample t test, chi-square test, and multiple linear regression. P value < 0.05 was considered statistically significant.

Results: We found that compared to men, women hospitalized with IBD are more likely to get infected with C. diff (4.2% vs 4.5%, P = < 0.001). Older IBD patients (Mean age of 53.1) are at risk compared to other age groups (P = < 0.001). Whites had the least C. diff rates compared to blacks, Hispanics, Asians, Native America, and others (4.2% vs 4.7% vs 5.6% vs 5.3% vs 4.4% vs 4.5%, P = < 0.001). IBD patients with anemia and thrombocytopenia had a significantly higher rate of C. diff infection (P = < 0.001). Interestingly, nicotine dependence and peritoneal abscess protected against C. diff infection (P = < 0.001 and 0.008). The average total hospital cost among IBD patients with C. diff was $20,254 higher compared to those without C. diff after controlling the effects of the variables - age, gender, race, nicotine status, anemia, ESRD, peritoneal abscess, thrombocytopenia, gastrointestinal bleed, and vesicovaginal fistula. The odds of mortality among IBD patients with C. diff was more than twice compared to those without C. diff (OR = 2.1, p = < 0.001).

Discussion: IBD patients remain at increased risk of C. diff infection and more hospital expenses. Hence, clinicians should rule out C. diff infection first in every IBD patient presenting with disease flare-ups or diarrhea.



Disclosures:


Onyinye Ugonabo, MD¹, Rajan Lamichhane, PhD, MSc², Khwaja S. Haq, MD³, Pramod Pantangi, MD², Mohamed Hammad, MD², Shima Ghavimi, MD⁴. P0691 - In-Hospital Mortality, Outcomes, and Cost Analysis of Hospitalized C. difficile Patients With Inflammatory Bowel Disease: A Nationwide Sample Study, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.