Duggal, Shivangini

Introduction: Clostridioides difficile infection (CDI) is a major complication in patients with inflammatory bowel disease (IBD), contributing to increased morbidity, mortality, and health care burden. This study aimed to evaluate national trends and clinical outcomes associated with CDI in hospitalized IBD patients in the United States. Methods: We conducted a retrospective cohort study using the National Inpatient Sample (NIS) from 2012 to 2021. Adult patients hospitalized with a primary or secondary diagnosis of IBD (Crohn’s disease or ulcerative colitis) were stratified into 2 groups by the status of CDI diagnosis (either primary or secondary diagnosis). Demographic characteristics, hospital outcomes, and complications were compared between CDI and non-CDI cohorts. Multivariable logistic regression was used to identify independent predictors of in-hospital mortality, septic shock, and venous thromboembolism (VTE). Results: Among 4,193,564 hospitalized IBD patients, 534,190 (12.7%) had CDI. CDI patients were older (mean: 68.8 vs 53.3 y, P < 0.001), with higher in-hospital mortality (3.6% vs 2.0%, P < 0.001), VTE (23.7% vs 6.2%, P < 0.001), septic shock (5.4% vs 4.0%, P < 0.001), and mechanical ventilation use (4.2% vs 2.8%, P < 0.001). Ulcerative colitis was more frequently associated with CDI than Crohn’s disease (30.3% vs 25.0%, P < 0.001) and independently predicted septic shock (OR: 1.09) and VTE (OR: 1.06) but was associated with lower mortality (OR: 0.81). Conclusion: The presence of CDI in hospitalized patients with IBD led to significantly worse outcomes. Ulcerative colitis is more commonly associated with CDI and increased risk of complications. These findings highlight the need for early detection, preventive strategies, and tailored management of CDI in the IBD population.