Dr Preethi Venkat Discusses Impact of Recurrent C difficile Hospitalizations in Patients With IBD

At Digestive Disease Week 2022, Preethi Venkat, MD, second-year internal medicine resident at University of California, San Diego, talks about the importance of her findings on recurrent Clostridioides difficile (C diff) infection in patients with inflammatory bowel disease (IBD).

What made you conduct your study on recurrent C. diff infection in patients with IBD?

Looking at the existing literature, we know that patients with inflammatory bowel disease (IBD) are more likely to be hospitalized with C diff compared to the general population, and are more likely to have recurrent C diff infections and are actually about 32% more likely to be hospitalized with recurrent C diff compared to the general population. We know that this is a considerable problem in the IBD community. We also know that patients with IBD who become hospitalized for a C diff infection have inferior outcomes, including increased risk of inpatient mortality, increased need for gastrointestinal surgery, longer inpatient stays, and that's compared to patients with IBD who are hospitalized for alternative reasons.

Really, we don't have very much data on comparative outcomes in patients with IBD who are hospitalized with recurrent C diff infection compared to those who are hospitalized with just a single episode of C diff, so that's what led us to conduct this study and examine that question further. It's important because we think, in practice, knowing the answer to this question may better inform how aggressively IBD specialists should pursue therapies—for example, fecal transplant—for their IBD patients to prevent C diff recurrence.

What did your study find?

We used the nationwide readmissions database to identify patients with IBD who were hospitalized at least twice in a 6-month period, and we controlled for the number of hospitalizations because we know that prior hospitalization is one of the strongest risk factors for recurrent hospitalization. Some of the outcomes we looked at, we compared rates of 6-month readmission, annualized time spent hospitalized and the cost across hospitalizations, inpatient mortality, and the risk of IBD-related procedures and surgeries, and we looked at those outcomes between 2 analysis groups.

The first group looked at patients with IBD who were hospitalized with a single episode or a single hospitalization for C diff, and we compared those patients to those who were hospitalized with recurrent C diff admissions. That was the primary analysis group, and then the second group was looking at patients who were hospitalized with 1 or more C diff infections, compared to those who were hospitalized at least twice in that 6-month period, but for non-C diff-related reasons. That secondary comparator group is the group that we already have some existing literature to suggest that those who are hospitalized specifically for C diff tend to do more poorly.

What we found in that second group—sort of as expected, as anticipated—we found that overall outcomes were worse for patients admitted once for C diff infection compared to those who were admitted for alternative reasons. But interestingly, and kind of contrary to our hypothesis, the risk of adverse outcomes did not seem to be increased with recurrent admissions for C diff compared to a single admission for C diff.