IBD and C. Difficile Make Deadly Combination

MILWAUKEE, Sept. 26 -- A Clostridium difficile infection sharply increases the risk of death for patients with underlying inflammatory bowel disease, researchers here said.

People admitted to the hospital with a combination of C. difficile and either Crohn's disease or ulcerative colitis were nearly five times as likely to die as those admitted for inflammatory bowel disease alone, according to David Binion, M.D., and colleagues at Wisconsin College of Medicine.

They were also more likely to die than patients admitted with just C. difficile associated disease, Dr. Binion and colleagues reported in the online issue of Gut.

Doctors should engage in "prudent use of antibiotics" patients with inflammatory bowel disease to reduce the incidence of C. difficile disease, the researchers said.

Their findings came from an analysis of the Healthcare Cost and Utilization Project's Nationwide Inpatient Sample for 2003. The sample for that year covered 37 states, 994 hospitals of all sizes and types, and more than 38 million discharges.

The investigators found that the discharge diagnosis was both C. difficile and inflammatory bowel disease in 2,804 cases, C. difficile alone in 44,400 cases, and inflammatory bowel disease alone in 77,366 cases.

A multivariate analysis showed that:

• Patients with both conditions were significantly more likely (at P

Also, they said, it is possible that some patients classified as having inflammatory bowel disease alone also had mild C. difficile disease, but were not tested for the toxin, which would reduce the magnitude of the associations.