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Objective: Clostridium difficile colitis has become a significant problem among healthcare facilities in the United States. Our objective is to analyze Clostridium difficile colitis associated hospitalizations and contemporary outcomes.

Methods: Analysis of the Nationwide Inpatient Sample (NIS) was performed for the years 2005-2007. This database incorporates 100% of all hospital discharges from a 20% stratified sample of US hospitals. Diagnosis and procedures were identified using ICD-9 codes. Primary outcomes were in-hospital mortality and need for surgical intervention. Multivariable analysis was performed to determine the relationship between independent variables and in-hospital mortality.

Results: 859,350 discharges were identified with a diagnosis of Clostridium difficile colitis. The mean age of the population was 68.5 ± 19.4 years (Female 58.8%), and the median length of stay was 8.0 days (0-360). Overall in-hospital mortality was 8.1%. Total abdominal colectomy was performed in 6722 patients (0.8%). Multivariable analysis revealed that patients who underwent total abdominal colectomy had a higher mortality rate than patients that did not require surgical intervention, 31.8% vs.7.8%, respectively (OR 4.0, 95% CI 3.7-4.3, p< 0.0001). In addition to total abdominal colectomy, acute renal failure was independently associated with an increase in in-hospital mortality (OR 2.8, 95% CI 2.7-2.8, p< 0.0001).

Conclusions: Clostridium difficile colitis is a serious problem that carries significant morbidity and mortality. The majority of the patients did not require surgery, but those who did had a fourfold increase in mortality risk. Patients over 65 years old and those who develop acute renal failure also had a higher risk of in-hospital mortality.

Multivariable Analysis of Risk Factors Associated with In-hospital Mortality in Patients with Clostridium difficile Colitis.

n= 859,350	Odds Ratio	95% CI.	p
Total abdominal colectomy	4.0	3.71-4.30	<0.0001
White	1.0	1.01-1.06	0.06
Female	09	0.92-0.95	<0.0001
Age over 65	1.5	1.5-1.6	<0.0001
CHF	1.2	1.2-1.3	<0.0001
HTN	0.8	0.8-0.9	<0.0001
COPD	1.1	1.1-1.2	<0.0001
CRF	1.0	0.9-1.0	0.2
DM	0.5	0.5-0.6	<0.0001

CHF: Congestive heart failure , , HTN: Hypertension, COPD: Chronic obstructive pulmonary disease ,CRF: Chronic renal failure, , DM: Diabetes mellitus.