A patient with inflammatory bowel disease is four times as likely to die from Clostridium difficile infection compared to a person who does not have the disease, according to an article published ahead of print in the journal Gut (BMJ).

The number of new cases of C difficile infection has been steadily rising over the last few years. C difficile is a major cause of diarrhea among inpatients, say the writers.

The researchers examined a representative sample of community hospital admissions in The United States for 2003, covering 994 hospitals in 37 states, including 124,570 patients.

44,400 of these patients had been hospitalized with C difficile infection, while 77,366 had inflammatory bowel disease (IBD). Inflammatory bowel disease includes Crohn's disease or ulcerative colitis. 2,804 of the patients had both C difficile infection and IBD.

The average age of those who had just the infection was 73. The average age of those with IBD was 42. The researchers found that the risk of death was higher for those with C difficile infection alone, or in combination with IBD, than patients with IBD alone. However, those who had both IBD and C difficile infection were four times more likely to die than the other patients - this was regardless of age.

Patients with both IBD and C difficile infection also remained in hospital for three days longer than the other patients, their rates of endoscopy were also higher.

The writers report that patients with ulcerative colitis tended to suffer from more serious C difficile infections and had worse outcomes than patients with Crohn's disease. They concluded that a patient with IBD may be especially susceptible to C difficile infection.

"Excess hospitalisation burden associated with Clostridium difficile in patients with inflammatory bowel disease"
Ashwin N Ananthakrishnan, Emily L McGinley, David G Binion
Online First Gut 2007; doi: 10.1136/gut.2007.128231
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