Post-Discharge Outcomes of Elderly Patients Hospitalized for Inflammatory Bowel Disease Flare Complicated by Clostridioides difficile Infection

Idan Goren^{1

2}, Ortal Fallek Boldes³, Tomer Boldes⁴, Oleg Knyazev^{5

6}, Anna Kagramanova^{5

7}, Jimmy K Limdi^{8

9}, Eleanor Liu⁹, Karishma Sethi-Arora⁸, Tom Holvoet^{10

11}, Piotr Eder¹², Cristina Bezzio^{13

14}, Simone Saibeni¹⁵, Marta Vernero^{15

16}, Eleonora Alimenti^{15

17}, María Chaparro¹⁸, Javier P Gisbert¹⁸, Eleni Orfanoudaki¹⁹, Ioannis E Koutroubakis¹⁹, Daniela Pugliese²⁰, Giuseppe Cuccia²¹, Cristina Calviño Suarez²², Davide Giuseppe Ribaldone¹⁶, Ido Veisman²³, Kassem Sharif²³, Stefano Festa²⁴, Annalisa Aratari²⁵, Claudio Papi²⁵, Iordanis Mylonas²⁵, Gerassimos J Mantzaris²⁵, Marie Truyens²⁶, Triana Lobaton Ortega²⁷, Stéphane Nancey²⁸, Fabiana Castiglione²⁹, Olga Maria Nardone³⁰, Giulio Calabrese³⁰, Konstantinos Karmiris³¹, Magdalini Velegraki³¹, Angeliki Theodoropoulou³¹, Ariella Bar-Gil Shitrit³², Milan Lukas³³, Gabriela Vojtechová³³, Pierre Ellul³⁴, Luke Bugeja³⁴, Edoardo V Savarino³⁵, Tali Sharar Fischler¹, Iris Dotan¹, Henit Yanai¹

Affiliations

¹ Division of Gastroenterology, Rabin Medical Center, Affiliated with the Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel.
² Division of Gastroenterology, SUNY Upstate Medical University, Syracuse, NY, USA.
³ Department of Internal Medicine E, Rabin Medical Center, Affiliated with the Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel.
⁴ Department of Otolaryngology, Meir Medical Center, Affiliated with the Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel.
⁵ Moscow Clinical Scientific Center named after A. S. Loginov, Moscow, Russia.
⁶ National Medical Research Center of Coloproctology named after A. N. Ryzhykh, Moscow, Russia.
⁷ Research Institute of Health Organization and Medical Management, Moscow, Russia.
⁸ Division of Gastroenterology, Northern Care Alliance Hospitals NHS Foundation Trust, Manchester, UK.
⁹ Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK.
¹⁰ Department of Gastroenterology, VITAZ, St Niklaas, Belgium.
¹¹ Department of Gastroenterology, University Hospital Ghent, Ghent, Belgium.
¹² Department of Gastroenterology, Dietetics and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland.
¹³ IBD Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.
¹⁴ Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.
¹⁵ Department of Gastroenterology, ASST Rhodense, Rho, Italy.
¹⁶ Department of Medical Sciences, University of Turin, Turin, Italy.
¹⁷ Department of Medical Sciences, University of Pavia, Gastroenterology Unit, Pavia, Italy.
¹⁸ Departement of Gastroenterology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (JjS-Princesa), Universidad Autónoma de Madrid, and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain.
¹⁹ Department of Gastroenterology, University Hospital of Heraklion, Heraklion, Greece.
²⁰ CEMAD - IBD UNIT - Unità Operativa Complessa di Medicina Interna e Gastroenterologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy.
²¹ Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy.
²² Department of Gastroenterology and Hepatology, University Hospital of Santiago de Compostela, La Coruña, Spain.
²³ Department of Gastroenterology, Sheba Medical Center, affiliated to Faculty of Medicine, Tel Aviv University, Israel, Department of Gastroenterology, Ramat Gan, Israel.
²⁴ IBD Unit, San Filippo Neri Hospital, Rome, Italy.
²⁵ Department of Gastroenterology, S. Filippo Neri Hospital, Gastroenterology, Rome, Italy and Department of Gastroenterology, Evangelismos-Polycliniki General Hospital, Athens, Greece.
²⁶ Department of Gastroenterology, Evangelismos-Polycliniki General Hospital, Athens, Greece.
²⁷ Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium.
²⁸ Dept. de Gastroenterologie, South Lyon University Hospital, Hospices Civils de Lyon, Lyon, France.
²⁹ Department of Clinical Medicine and Surgery, Federico Jj University, Gastroenterology, Naples, Italy.
³⁰ Department of Public Health, University of Naples Federico Jj, Gastroenterolog, Naples, Italy.
³¹ Department of Gastroenterology, Venizeleio General Hospital, Heraklion, Greece.
³² IBD MOM Unit, Digestive Diseases Institute, Shaare Zedek Medical Center, affiliated with the Hebrew University, Jerusalem, Israel.
³³ Clinical and Research Center for Inflammatory Bowel Disease ISCARE and First Faculty of Medicine, Charles University, Prague, Czech Republic.
³⁴ Division of Gastroenterology, Mater Dei Hospital, Birkirkara, Malta.
³⁵ Department of Surgery, Oncology and Gastroenterology, Division of Gastroenterology, University of Padua, Padua, Italy.

PMID: 39435855
DOI: 10.1093/ecco-jcc/jjae161

Multicenter Study

Post-Discharge Outcomes of Elderly Patients Hospitalized for Inflammatory Bowel Disease Flare Complicated by Clostridioides difficile Infection

Idan Goren et al. J Crohns Colitis. 2025.

. 2025 May 8;19(5):jjae161.

doi: 10.1093/ecco-jcc/jjae161.

Authors

Affiliations

¹ Division of Gastroenterology, Rabin Medical Center, Affiliated with the Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel.
² Division of Gastroenterology, SUNY Upstate Medical University, Syracuse, NY, USA.
³ Department of Internal Medicine E, Rabin Medical Center, Affiliated with the Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel.
⁴ Department of Otolaryngology, Meir Medical Center, Affiliated with the Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel.
⁵ Moscow Clinical Scientific Center named after A. S. Loginov, Moscow, Russia.
⁶ National Medical Research Center of Coloproctology named after A. N. Ryzhykh, Moscow, Russia.
⁷ Research Institute of Health Organization and Medical Management, Moscow, Russia.
⁸ Division of Gastroenterology, Northern Care Alliance Hospitals NHS Foundation Trust, Manchester, UK.
⁹ Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK.
¹⁰ Department of Gastroenterology, VITAZ, St Niklaas, Belgium.
¹¹ Department of Gastroenterology, University Hospital Ghent, Ghent, Belgium.
¹² Department of Gastroenterology, Dietetics and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland.
¹³ IBD Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.
¹⁴ Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.
¹⁵ Department of Gastroenterology, ASST Rhodense, Rho, Italy.
¹⁶ Department of Medical Sciences, University of Turin, Turin, Italy.
¹⁷ Department of Medical Sciences, University of Pavia, Gastroenterology Unit, Pavia, Italy.
¹⁸ Departement of Gastroenterology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (JjS-Princesa), Universidad Autónoma de Madrid, and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain.
¹⁹ Department of Gastroenterology, University Hospital of Heraklion, Heraklion, Greece.
²⁰ CEMAD - IBD UNIT - Unità Operativa Complessa di Medicina Interna e Gastroenterologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy.
²¹ Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy.
²² Department of Gastroenterology and Hepatology, University Hospital of Santiago de Compostela, La Coruña, Spain.
²³ Department of Gastroenterology, Sheba Medical Center, affiliated to Faculty of Medicine, Tel Aviv University, Israel, Department of Gastroenterology, Ramat Gan, Israel.
²⁴ IBD Unit, San Filippo Neri Hospital, Rome, Italy.
²⁵ Department of Gastroenterology, S. Filippo Neri Hospital, Gastroenterology, Rome, Italy and Department of Gastroenterology, Evangelismos-Polycliniki General Hospital, Athens, Greece.
²⁶ Department of Gastroenterology, Evangelismos-Polycliniki General Hospital, Athens, Greece.
²⁷ Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium.
²⁸ Dept. de Gastroenterologie, South Lyon University Hospital, Hospices Civils de Lyon, Lyon, France.
²⁹ Department of Clinical Medicine and Surgery, Federico Jj University, Gastroenterology, Naples, Italy.
³⁰ Department of Public Health, University of Naples Federico Jj, Gastroenterolog, Naples, Italy.
³¹ Department of Gastroenterology, Venizeleio General Hospital, Heraklion, Greece.
³² IBD MOM Unit, Digestive Diseases Institute, Shaare Zedek Medical Center, affiliated with the Hebrew University, Jerusalem, Israel.
³³ Clinical and Research Center for Inflammatory Bowel Disease ISCARE and First Faculty of Medicine, Charles University, Prague, Czech Republic.
³⁴ Division of Gastroenterology, Mater Dei Hospital, Birkirkara, Malta.
³⁵ Department of Surgery, Oncology and Gastroenterology, Division of Gastroenterology, University of Padua, Padua, Italy.

PMID: 39435855
DOI: 10.1093/ecco-jcc/jjae161

Erratum in

Correction to: Post-Discharge Outcomes of Elderly Patients Hospitalized for Inflammatory Bowel Disease Flare Complicated by Clostridioides difficile Infection.
[No authors listed] [No authors listed] J Crohns Colitis. 2025 May 8;19(5):jjaf071. doi: 10.1093/ecco-jcc/jjaf071. J Crohns Colitis. 2025. PMID: 40372820 No abstract available.

Abstract

Objectives: Elderly hospitalized patients with inflammatory bowel disease (IBD) flare and concurrent Clostridioides difficile infection (CDI) are considered at high risk of IBD-related complications. We aimed to evaluate the short-,intermediate-, and long-term post-discharge complications among these patients.

Methods: A retrospective multicenter cohort study assessing outcomes of elderly individuals (≥60 years) hospitalized for an IBD flare who were tested for CDI (either positive or negative) and discharged. The primary outcome was the 3-month post-discharge IBD-related complication rates defined as steroid dependency, re-admissions (emergency department or hospitalization), IBD-related surgery, or mortality. We assessed post-discharge IBD-related complications within 6 month and mortality at 12 month among secondary outcomes. Risk factors for complication were assessed by multivariable logistic regression.

Results: In a cohort of 654 patients hospitalized for IBD {age 68.9 (interquartile range [IQR]): 63.9-75.2 years, 60.9% ulcerative colitis (UC)}, 23.4% were CDI-positive. Post-discharge complication rates at 3 and 6 months, and 12 months mortality, did not differ significantly between CDI-positive and CDI-negative patients (32% vs 33.1%, p = 0.8; 40.5% vs 42.5%, p = 0.66; and 4.6% vs 8%, p = 0.153, respectively). The Charlson comorbidity index was the only significant risk factor for complications within 3 months (aOR 1.1), whereas mesalamine (5-aminosalicylic acid [5-ASA]) use was protective (aOR 0.6). An UC diagnosis was the sole risk factor for complication at 6 months (aOR 1.5). Clostridioides difficile infection did not significantly impact outcomes or interact with IBD type.

Conclusions: In elderly IBD patients hospitalized for IBD flare and subsequently discharged, a concurrent CDI infection was not associated with post-discharge IBD-related complications or mortality up to 1 year.

Keywords: Clostridioides difficile; Inflammatory bowel disease; elderly; hospitalization; mortality; outcomes.

© The Author(s) 2024. Published by Oxford University Press on behalf of European Crohn’s and Colitis Organisation. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.

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Post-Discharge Outcomes of Elderly Patients Hospitalized for Inflammatory Bowel Disease Flare Complicated by Clostridioides difficile Infection

Affiliations

Post-Discharge Outcomes of Elderly Patients Hospitalized for Inflammatory Bowel Disease Flare Complicated by Clostridioides difficile Infection

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Affiliations

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