C Diff Infection Associated With Poorer Outcomes for Patients with Chronic Pancreatitis

Patients with chronic pancreatitis (CP) who also have Clostridium difficile infection (CDI) suffered worse outcomes, including higher mortality rates, than those without CDI, according to a new study.

The study, presented at the American College of Gastroenterology (ACG) 2020 conference, also found longer hospital stays and higher hospitalization costs among patients with both CP and CDI.

“CP with CDI patients reported significantly higher prevalence of comorbidities,” the investigators wrote on their poster presentation. “Complications such as dehydration and electrolyte disorders, septicemia, ascites, hypoalbuminemia were significantly higher in the CDI group, while alcohol abuse and acute pancreatitis were higher in the non-CDI group.”

Led by Himanshu Kavani, MD, of St. Mary Medical Center in Levittown, PA, the study evaluated 159615 CP patients, including 4550 (2.85%) who also had CDI between October 2015 and December 2017, according to the Nationwide Inpatient Sample database.

There were more female CP patients with CDI (53.3%) and more male patients with CP alone (57.6), among the non-CDI group 87.7% were under 65 years of age compared with 78.4% of those with CDI, and Medicare was the primary form of insurance among those with CDI (42.1%) compared with Medicaid (31.4%) of those in the non-CDI group.

CDI, which is a leading cause of gastrointestinal death, was associated with a higher risk of mortality (0.8% vs 0.2%, p < 0.0001; adjusted OR (95% CI): 1.49 (1.04–2.13), p=0.02), according to the study, which used multivariate logistic regression to analyze adjusted mortality. Average hospital stays were 5 days for CP patients with CDI compared with 3 for the non-CDI group of CP patients. Average hospital costs also were higher among CP patients with CDI ($8802 vs $5921).

Prevalence of comorbidities also was higher among CP patients with CDI compared with those in the non-CDI group, including diabetes mellitus (31.9% vs 29.7%), liver diseases (24.2% vs 17.1%), renal failure (18.1% vs 7.7%), weight loss (23.2% vs 10.6%), fluid & electrolyte disorders (57.6% vs 37.1%), and coagulopathy (13.2% vs 6.4%).

CP patients with CDI had a higher risk of complications compared with those in the non-CDI group, including dehydration and electrolyte disorders (63.1% vs 39.2%), septicemia (5.2% vs 1.2%), ascites (4.2% vs 2.3%,) and hypoalbuminemia (2.6% vs 0.9%).

Those in the non-CDI group were more likely to experience alcohol abuse (30.9% vs 37.8%) and acute pancreatitis (35.9% vs 82.9%).

“Future studies should be targeted towards prevention of CDI in patients with CP,” the investigators wrote.

The study is among the most recent to examine how C Diff affects the outcomes of patients with other conditions that frequently require hospitalization.

A similar study, published last year in the journal Pancreas, found that patients with CP had a higher risk of CDI (adjusted odds ratio, 2.03 [95% CI, 1.87-2.19]). That study, which included 32,614 CP patients from 2007 to 2014 in the NIS database, also found worse outcomes among CP patients with concomitant CDI, including a higher risk of acute kidney injury, longer hospitalization and higher costs.

An earlier study looked at patients with cirrhosis and found the CDI was associated with higher rates of overall mortality compared with cirrhosis patients who did not have CDI at index admission (17.9% vs 7.4%).

Ken Blount, MD, of Rebiotix Inc. in Roseville, Minn., recently discussed CDI with Contagion® describing it as “the original microbiome disease,” and noted that broad-spectrum antibiotics are the biggest risk factor for CDI.