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. 2022 Mar 26;22(1):140.
doi: 10.1186/s12876-022-02223-y.

Effect of clinical versus administrative data definitions on the epidemiology of C. difficile among hospitalized individuals with IBD: a population-based cohort study

Seth R Shaffer  1   2 , Zoann Nugent  2   3 , Charles N Bernstein  1   2 , Andrew Walkty  2 , Harminder Singh  4   5   6   7
Affiliations

Effect of clinical versus administrative data definitions on the epidemiology of C. difficile among hospitalized individuals with IBD: a population-based cohort study

Seth R Shaffer et al. BMC Gastroenterol. .

Abstract

Background: Hospitalization admissions and discharge databases (DAD) using the International Classification of Diseases (ICD) codes are often used to describe the epidemiology of Clostridioides difficile infections (CDI) among those with Inflammatory bowel disease (IBD), even though DAD CDI definition can miss many cases of CDI. There are no data comparing the assessment of the epidemiology of CDI among those with IBD by DAD versus laboratory diagnosis. We used a population-based dataset to determine the effect of using DAD versus laboratory CDI diagnosis on CDI assessment among those with IBD.

Methods: We linked the University of Manitoba IBD Epidemiology Database to the provincial CDI laboratory dataset for the years 2005-2014. Time trends of CDI were assessed using joinpoint analyses. We used stratified logistic regression analysis to assess factors associated with CDI among individuals with IBD.

Results: Time trends of CDI among hospitalized individuals with IBD were similar when using DAD or the laboratory CDI diagnosis. Prior hospital admission and antibiotic exposure were associated with CDI using either of the CDI definitions, 5-ASA use was associated with CDI using DAD but not laboratory diagnosis, whereas corticosteroid exposure was associated with laboratory-based CDI diagnosis. Using laboratory results as gold standard, DAD had a sensitivity and specificity of 75.4% and 99.6% for CDI among those with IBD.

Conclusions: Using ICD codes in the DAD for CDI provides similar epidemiological time trend patterns as identifying CDI in the laboratory dataset. Hence, ICD codes are reliable to determine CDI epidemiology among hospitalized individuals with IBD.

Keywords: Case definition; Clostridioides difficile; Epidemiology; IBD.

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Conflict of interest statement

There are no direct competing interests to the study materials and content. However, the financial industry disclosures include: Dr. Shaffer has consulted to Takeda Canada. Dr. Bernstein has served on advisory boards or consulted to Abbvie Canada, Amgen Canada, Janssen Canada, Pfizer Canada, Roche Canada, Sandoz Canada, Takeda, and Mylan Pharmaceuticals, and has received unrestricted educational grants from Abbvie Canada, Janssen Canada, Pfizer Canada, and Takeda Canada. He has been on the speaker’s bureau for Abbvie Canada, Takeda Canada, Janssen Canada and Medtronic Canada. He has received investigator initiated grants from Abbvie Canada and Pfizer Canada. Dr. Singh has been on advisory boards or consulted to Amgen Canada, Roche Canada, Sandoz Canada, Takeda Canada, and Guardant Health, Inc., Rest of the authors have no potential conflicts of interest to declare.

Figures

Fig. 1
Fig. 1
Annual CDI infection rates in IBD and those without IBD according to laboratory dataset (Lab) and Hospitalization Admission and Discharge Database (DAD) (A047). Annual percentage change and p values: IBD Lab: 0.89, 0.81; IBD DAD: 2.53,0.45; Non-IBD Lab: − 4.66, 0.12; Non-IBD Lab − 5.48, 0.02
Fig. 2
Fig. 2
Odds ratio of CDI in IBD compared to those without IBD using laboratory dataset (Lab) and hospitalization admission and discharge database (DAD) (A047)
Fig. 3
Fig. 3
Correlation of CDI in the Laboratory dataset and Hospitalization Admission and Discharge Database (DAD) CDI diagnosis through the study years
See this image and copyright information in PMC

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