Disproportionate Rise in Clostridium difficile–Associated Hospitalizations Among US Youth With Inflammatory Bowel Disease, 1997–2011
Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal's Web site (www.jpgn.org).
K.C.S.'s work was supported in part by a grant from the National Institute of Child Health and Human Development (T32 HD07534). M.M.D. is funded in part by the Michigan Department of Community Health, which is unrelated to this study; the analyses and statements contained herein are those of the authors and not necessarily of the Michigan Department of Community Health. J.A. is funded in part by the Crohn's and Colitis Foundation of America and by Blue Cross Blue Shield of Michigan Foundation, which are unrelated to this study. A.G. has no conflicts of interest to disclose.
ABSTRACT
Objectives:
Our aim was to characterize the temporal changes in burden that Clostridium difficile infection (CDI) added to the hospital care of children and young adults with inflammatory bowel disease (IBD) in the United States.
Methods:
Retrospective analysis of annual, nationally representative samples of children and young adults with IBD.
Results:
There was a 5-fold increase in IBD hospitalizations with CDI from 1997 to 2011 (P for trend <0.01). During the same period, IBD hospitalizations without CDI increased 2-fold (P for trend <0.01). Mean length of stay for IBD hospitalizations with CDI was consistently longer than that for hospitalizations without CDI and did not significantly change over time (P for trend = 0.47). CDI-related total hospital days in the United States rose from 1702 to 10,194 days per million individuals per year from 1997 to 2011 (P for trend <0.01). Children and young adults hospitalized with CDI had a significantly lower odds of colectomy (0.31) compared with those without CDI. Total charges for CDI-related hospitalizations among children and young adults in the United States rose from $8.7 million in 1997 to $68.2 million in 2011.
Conclusions:
A widening gap in burden has opened between IBD hospitalizations with and without CDI during the last decade and a half. CDI-related hospitalizations are associated with disproportionately longer lengths of stay, more hospital days, and more charges than hospitalizations without CDI over time. Further work within health systems, hospitals, and practices can help us better understand this enlarging gap to improve clinical care for this vulnerable population.
