S1725 Impact of Clostridioides difficile Infection on Inpatient Outcomes in Crohn’s Disease: A National Inpatient Analysis

Introduction: Clostridioides difficile infection (CDI) poses a serious complication in patients with inflammatory bowel disease, including Crohn’s disease (CD). While CDI has been well studied in ulcerative colitis, its impact in hospitalized CD patients at the national level remains poorly understood. We aimed to evaluate the association between CDI and inpatient outcomes among CD hospitalizations in the United States. Methods: We conducted a retrospective cross-sectional study using the 2018–2022 National Inpatient Sample (NIS), the largest publicly available all-payer inpatient healthcare database in the United States. Adult hospitalizations with a principal or secondary diagnosis of Crohn’s disease were identified. CDI was identified as a co-diagnosis during the same admission. The primary outcome was in-hospital mortality. Secondary outcomes included colectomy during admission, length of stay (LOS), and total hospital charges. Multivariable logistic regression was used to estimate adjusted odds ratios (aOR) for binary outcomes (mortality, colectomy), while linear regression models assessed the association between CDI and continuous outcomes (LOS and total charges). All models were adjusted for age, sex, race, primary payer, income quartile by ZIP code, comorbidities (diabetes, hypertension, congestive heart failure), and hospital-level characteristics (bed size and geographic region). Statistical significance was defined as P < 0.05. Results: Among an estimated 722,345 Crohn’s disease hospitalizations, 17,610 (2.4%) were complicated by CDI. Patients with CDI were younger (mean age 53.8 vs 55.7 years), more often female (62.8% vs 59.1%), and more likely to have Medicare insurance. On adjusted analysis, CDI was associated with a 66.7% increase in the odds of in-hospital mortality (adjusted OR 1.67, 95% CI: 1.35–2.06, P < 0.001) and a 54% increase in the odds of undergoing colectomy (adjusted OR 1.54, 95% CI: 1.08–2.19, P = 0.016). Additionally, CDI was associated with an average increase of 2.71 days in length of stay and a 21.3% increase in total hospital charges, both statistically significant (P < 0.001). Conclusion: Clostridioides difficile infection is associated with significantly worse outcomes in hospitalized Crohn’s disease patients, including higher mortality, increased need for surgical intervention, prolonged hospitalization, and higher healthcare costs. These findings underscore the importance of targeted prevention and early management strategies for CDI in this high-risk population.