Journal Review

C. diff, inflammatory bowel disease a deadly combo

Patients with both four times more likely to die

Ananthakrishnan AN, McGinley EL, Binion DG. Excess hospitalisation burden associated with Clostridium difficile in patients with inflammatory bowel disease. Gut 2007; 0:1-6. doi:10.1136/gut.2007.128231.

Clostridium difficile infection is four times more likely to kill patients with inflammatory bowel disease, researchers report. The findings are based on a representative sample of community hospital admissions in the United States for 2003.

The sample covered 994 hospitals in 37 states and included a total of 124,570 patients. Of those, 44,400 had been admitted with C. diff infection, and 77,366 had been admitted with inflammatory bowel disease (IBD), primarily Crohn's disease or ulcerative colitis. A total of 2,804 had both IBD and C. diff infection. Patients with both C. diff and IBD were four times more likely to die than patients with just IBD or C. diff infection alone, irrespective of age. Patients with the combination also stayed in the hospital three days longer and had higher rates of endoscopy. Patients with ulcerative colitis had more severe C. diff infection than those with Crohn's disease and worse outcomes.

"It is important for clinicians treating patients with IBD in all hospitals to have a high degree of awareness about this complication in these patients," the authors conclude. "The significant health care burden associated with C. difficile in the IBD population necessitates a prudent use of antibiotics in this group to decrease the incidence of this complication. Early recognition and institution of appropriate treatment is essential to improve outcomes from this disease."