1488. Effects of Clostridium difficile Infection in Hospitalized Patients with Inflammatory Bowel Disease, National Inpatient Sample Study 2016

Abstract Background Patients with inflammatory bowel disease (IBD) including ulcerative colitis (UC) and Crohn’s disease (CD) have been shown to have increased Clostridium difficile infection (CDI) rates. In this study, we aimed to determine the effects of concurrent CDI in the outcomes of hospitalized patients with IBD. Methods In this retrospective cohort study, we analyzed the 2016 National Inpatient Sample (NIS) database of hospitalized patients with a first or secondary diagnosis of IBD and CDI using their respective ICD-10 codes. Primary outcomes of interest were all-cause mortality, hospital length of stay, total cost for hospital stay, and rate of colectomy. Multivariate regression was used to adjust for age, gender, race, hospital bed size, and Charlson comorbidity index. We used STATA 14 for analysis. Results There were a total of 3,306 patients admitted with IBD and CDI, of which 1,864 had a diagnosis of UC and 1,460 had a diagnosis of CD. 58.02% of the cases were female and the mean age was 52.5 years old. The mean age of patients in the CD group (48.97 [47.79–50.15]) was lower than the UC group (55.16 [54.01–56.31]). The results of in-hospital outcomes are shown in Tables 1 and 2. Conclusion We observed a significant increase in all-cause mortality, hospital length of stay, and total cost for hospital stay in IBD patients with concurrent CDI. There was no statistical difference in the rate of colectomy. In the subgroup analysis, there was a statistically non-significant increase in all-cause mortality in the CD group and a statistically significant increase in all-cause mortality in the UC group. Thus, in our study, IBD patients, especially UC patients, with concurrent CDI had a worse prognosis but they did not have more colectomies. Disclosures All authors: No reported disclosures.

Download Full-text

M1143 Prospective Analysis of Risk Factors and Outcomes Associated with Clostridium difficile Infection in Hospitalized Patients with Inflammatory Bowel Disease

Gastroenterology ◽

10.1016/s0016-5085(09)61646-2 ◽

2009 ◽

Vol 136 (5) ◽

pp. A-359

Author(s):

Timothy L. Zisman ◽

David T. Rubin

Keyword(s):

Risk Factors ◽

Inflammatory Bowel Disease ◽

Clostridium Difficile ◽

Clostridium Difficile Infection ◽

Bowel Disease ◽

Hospitalized Patients ◽

Prospective Analysis ◽

Inflammatory Bowel

Download Full-text

Incidence and Outcome of Clostridium difficile Infection in Hospitalized Patients with Inflammatory Bowel Disease in the UK

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjw117 ◽

2016 ◽

Vol 11 (1) ◽

pp. 70-76 ◽

Cited By ~ 15

Author(s):

Neerav M. Joshi ◽

Isobel H. Marks ◽

Richard Crowson ◽

David Ball ◽

David S. Rampton

Keyword(s):

Inflammatory Bowel Disease ◽

Clostridium Difficile ◽

Clostridium Difficile Infection ◽

Bowel Disease ◽

Hospitalized Patients ◽

Inflammatory Bowel ◽

The Uk

Download Full-text

Low Risk of Clostridium difficile Infections in Hospitalized Patients with Inflammatory Bowel Disease in a German Tertiary Referral Center

Digestion ◽

10.1159/000324617 ◽

2011 ◽

Vol 84 (3) ◽

pp. 187-192 ◽

Cited By ~ 8

Author(s):

Claudia Ott ◽

Christiane Girlich ◽

Frank Klebl ◽

Annelie Plentz ◽

Igors Iesalnieks ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Clostridium Difficile ◽

Bowel Disease ◽

Hospitalized Patients ◽

Low Risk ◽

Tertiary Referral ◽

Tertiary Referral Center ◽

Referral Center ◽

Inflammatory Bowel

Download Full-text

216. Association Between Days to Initiate Appropriate Therapy and Hospital Length of Stay Among Adult Hospitalized Patients With Gram-negative Bloodstream Infections (GN-BSI)

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.291 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S127-S127

Author(s):

Thomas Lodise ◽

Hemanth Kanakamedala ◽

Wei-Chun Hsu ◽

Bin Cai

Keyword(s):

Length Of Stay ◽

Cohort Analysis ◽

Hospital Length ◽

Cox Proportional Hazards ◽

Hospitalized Patients ◽

Hospital Length Of Stay ◽

Healthcare Database ◽

Kaplan Meier ◽

Appropriate Therapy ◽

The Mean

Abstract Background The deleterious outcomes associated with delay receipt of appropriate therapy are well documented. However, scant data exists on the consequences of each day delay of appropriate therapy and subsequent outcomes among adult hospitalized patients with GN-BSIs. Methods Study design: a retrospective cohort analysis. Study population: consecutive adult, hospitalized patients with a GN-BSI (11 most prevalent pathogens) in 1 of 181 institutions contributing microbiology data to the Premier Healthcare Database (October 2010–Sep 2015). Exclusion criteria: age < 18 years; diagnosis of pregnancy or cystic fibrosis, died or discharged within 2 days of index GN-BSI culture, lack of sufficient antibiotic susceptibility or treatment data to determine appropriateness. Day of initiating appropriate therapy was defined as the first day when the patient received an antibiotic with in vitro activity against the GN-BSI post index culture. Results were summarized by Kaplan–Meier estimates, and Cox Proportional-Hazards (CPH) analyses modeling discharge to home were conducted. Time to initiate appropriate therapy (0, 1–2 days, 3–4 days, ≥5 days) was included in the CPH model as an ordinal variable. Results A total of 40,549 patients met selection criteria. Mean (SD) age was 67.5 (16.1) years and 54% were female. E. coli and K. pneumoniae were the most common GN-BSI (58.0% and 18.3%, respectively). Approximately 30% of patients were in the ICU at index GN-BSI and in-hospital mortality was 6.8%. The mean (SD) time to receive appropriate therapy post index GN-BSI culture was 0.6 (2.7) days, and 69.7%, 22.5%, 5.7% and 2.1% received appropriate therapy in 0, 1–2, 3–4, and ≥5 days of index GN-BSI, respectively. The mean/median LOS post index GN-BSI by 0, 1–2, 3–4, and ≥5 days delays in appropriate treatment were 8.3/6, 9.8/7, 11.5/8, and 19.2/11 days respectively. Kaplan–Meier plots are shown in Figure 1. In the CPH model, each interval delay in appropriate therapy was associated with a 21% decrease in the likelihood of being discharged home for patients with GB-BSIs. Conclusion Hospital length of stay was found to increase when appropriate therapy was delayed. These findings highlight the critical need for early appropriate therapy among patients with GN-BSIs. Disclosures All authors: No reported disclosures.

Download Full-text