Clostridium difficile infection (CDI) of the ileal pouch following restorative proctocolectomy has been increasingly recognized. We sought to evaluate the frequency and risk factors of C. difficile infection (CDI) among patients hospitalized with a primary or secondary discharge diagnosis of pouchitis in the United States.Methods:
We reviewed the National Inpatient Sample (NIS) of the Healthcare Cost and Utilization Project (HCUP) and identified patients admitted to the hospital for pouchitis with underlying inflammatory bowel disease (IBD) or familial adenomatous polyposis (FAP), between 2010 and 2012. Cases of CDI were identified based on a concomitant primary or secondary discharge diagnosis for CDI. The frequency of CDI was estimated in patients with underlying IBD and FAP. Multivariable analysis was performed to study the risk factors associated with CDI among patients with pouchitis with underlying IBD.Results:
A total of 3566 eligible patients with pouchitis were identified during the study period. Eighty-9 patients (2.5%) had CDI as a concomitant primary or secondary discharge diagnosis. CDI was identified in 2.6% (99.9% confidence interval [CI]: 1.3, 3.8) of pouchitis patients with underling IBD. None of the patients with pouchitis with underlying FAP were found to have CDI during the study period. Among pouchitis patients with underlying IBD, the presence of non-alcoholic fatty liver disease (NAFLD) (odds ratio [OR], 5.4, 95% confidence interval [CI], 1.5–19.9), obesity (OR, 5.5; 95% CI, 1.4–21.4), and obstructive sleep apnea (OR, 10.3; CI, 2.0–53.7) were associated with increased risk of CDI.Conclusions:
It appears that CDI was limited to pouchitis with underlying IBD, and rare in those with underlying FAP. Patients with NAFLD, obesity and obstructive sleep apnea are at an increased risk of C. difficile pouchitis among IBD patients.