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Abstract：
Background Enterocolitis due to Clostridium difficile infection (CDI) is one of the most common infectious causes of healthcare-associated diarrhea and a significant cause of morbidity and mortality among hospitalized patients. Gastroesophageal reflux disease (GERD) is notable for its high prevalence, variety of clinical presentations, and underrecognized morbidity. It is widely treated with acid suppression, both with over-the-counter and prescription medications. There are no studies evaluating the impact of GERD on CDI hospitalization. In this study, we aimed to analyze the influence of concomitant GERD on patients hospitalized for CDI enterocolitis. Methodology This was a retrospective, observational study where we extracted data from 2016 to 2020 from the National Inpatient Sample database. We included all patients hospitalized with a primary discharge diagnosis of CDI with or without a secondary diagnosis of GERD. We compared the demographics, comorbidities, and in-hospital outcomes between these two groups. Results This study identified 239,603 hospitalizations with a discharge diagnosis of CDI. Of these, 67,000 (28%) had a concurrent diagnosis of GERD. Patients with GERD had a higher prevalence of hypertension (41% vs. 35.5%, p < 0.01), hyperlipidemia (50% vs. 36.5%, p < 0.01), obesity (13.7% vs. 10.5%, p < 0.01), coronary artery disease (24.4% vs. 19.6%, p < 0.01), and chronic kidney disease (20.7% vs. 19.2%, p < 0.01). Notably, inpatient mortality was lower in CDI hospitalizations with GERD (0.66% vs. 1.46%, p < 0.01). The total hospital charge was reduced in the CDI with GERD group in comparison to the CDI without GERD group (39,599 vs. 43,589, p < 0.01). The length of hospital stay was similar between the two groups (5.3 vs. 5.4 days, p = 0.07). Regarding complications, CDI hospitalizations with GERD demonstrated lower rates of hypovolemic shock (0.5% vs. 0.73%, p = 0.06), septic shock (0.6% vs. 1.05%, p < 0.01), acute kidney injury (1.48% vs. 2.04%, p < 0.01), intestinal perforation (0.008% vs. 0.16%, p = 0.03), and lactic acidosis (0.008% vs. 0.16%, p = 0.03). Conversely, CDI patients with GERD had a higher rate of ileus (2.66% vs. 2.16%, p < 0.01). Conclusions Patients with CDI and concurrent GERD exhibited favorable in-hospital outcomes in terms of complication rates, mortality, and total hospital charges. Further research is required to comprehensively explore and validate these findings.
摘要：
背景艰难梭菌感染(CDI)引起的小肠结肠炎是医疗相关性腹泻最常见的感染性原因之一，也是住院患者发病和死亡的重要原因。胃食管反流病（GERD）以其高患病率而著称，各种临床表现，和未被认可的发病率。它被广泛的酸抑制处理，非处方药和处方药。没有研究评估GERD对CDI住院的影响。在这项研究中,我们旨在分析合并GERD对CDI小肠结肠炎住院患者的影响。方法这是一个回顾性的，观察性研究，我们从国家住院患者样本数据库中提取了2016年至2020年的数据。我们纳入了所有初次出院诊断为CDI且有或没有继发诊断为GERD的住院患者。我们比较了人口统计，合并症,以及这两组之间的住院结局。结果本研究确定了239,603例住院并诊断为CDI。其中,67,000（28％）同时诊断为GERD。GERD患者高血压患病率较高（41%vs.35.5%,p<0.01),高脂血症（50%vs.36.5%,p<0.01),肥胖症（13.7%vs.10.5%,p<0.01),冠状动脉疾病（24.4%vs.19.6%,p<0.01),和慢性肾病（20.7%vs.19.2%,p<0.01)。值得注意的是,CDI住院合并GERD患者的住院死亡率较低(0.66%vs.1.46%，p<0.01)。与无GERD的CDI组相比，有GERD的CDI组的总住院费用降低了（39,599vs.43,589，p<0.01)。两组的住院时间相似（5.3vs.5.4天,p=0.07)。关于并发症,CDI住院伴GERD患者低血容量性休克发生率较低（0.5%vs.0.73%，p=0.06),感染性休克（0.6%vs.1.05%,p<0.01),急性肾损伤（1.48%vs.2.04%,p<0.01),肠穿孔（0.008%vs.0.16%，p=0.03),和乳酸性酸中毒(0.008%vs.0.16%，p=0.03)。相反，CDI合并GERD患者的肠梗阻发生率较高(2.66%vs.2.16%,p<0.01)。结论CDI和并发GERD患者在并发症发生率方面表现出良好的院内预后。死亡率,和医院总费用。需要进一步的研究来全面探索和验证这些发现。
