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.

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

Clinical and Research Center for Inflammatory Bowel Disease ISCARE and 1st Faculty of Medicine Charles University Prague Czech Republic

Departement of Gastroenterology Hospital Universitario de La Princesa Instituto de Investigación Sanitaria Princesa Madrid Spain

Department of Biomedical Sciences Humanitas University Pieve Emanuele Milan Italy

Department of Clinical Medicine and Surgery Federico Jj University Gastroenterology Naples Italy

Department of Gastroenterology and Hepatology University Hospital of Santiago de Compostela La Coruña Spain

Department of Gastroenterology ASST Rhodense Rho Italy

Department of Gastroenterology Dietetics and Internal Medicine Poznan University of Medical Sciences Poznan Poland

Department of Gastroenterology Evangelismos Polycliniki General Hospital Athens Greece

Department of Gastroenterology S Filippo Neri Hospital Gastroenterology Rome Italy and Department of Gastroenterology Evangelismos Polycliniki General Hospital Athens Greece

Department of Gastroenterology Sheba Medical Center affiliated to Faculty of Medicine Tel Aviv University Israel Department of Gastroenterology Ramat Gan Israel

Department of Gastroenterology University Hospital Ghent Ghent Belgium

Department of Gastroenterology University Hospital of Heraklion Heraklion Greece

Department of Gastroenterology Venizeleio General Hospital Heraklion Greece

Department of Gastroenterology VITAZ St Niklaas Belgium

Department of Internal Medicine and Pediatrics Ghent University Ghent Belgium

Department of Internal Medicine E Rabin Medical Center Affiliated with the Faculty of Medical and Health Sciences Tel Aviv University Tel Aviv Israel

Department of Medical Sciences University of Pavia Gastroenterology Unit Pavia Italy

Department of Medical Sciences University of Turin Turin Italy

Department of Otolaryngology Meir Medical Center Affiliated with the Faculty of Medical and Health Sciences Tel Aviv University Tel Aviv Israel

Department of Public Health University of Naples Federico Jj Gastroenterolog Naples Italy

Department of Surgery Oncology and Gastroenterology Division of Gastroenterology University of Padua Padua Italy

Dept de Gastroenterologie South Lyon University Hospital Hospices Civils de Lyon Lyon France

Dipartimento Universitario di Medicina e Chirurgia Traslazionale Università Cattolica del Sacro Cuore Rome Italy

Division of Gastroenterology Mater Dei Hospital Birkirkara Malta

Division of Gastroenterology Northern Care Alliance Hospitals NHS Foundation Trust Manchester UK

Division of Gastroenterology Rabin Medical Center Affiliated with the Faculty of Medical and Health Sciences Tel Aviv University Tel Aviv Israel

Division of Gastroenterology SUNY Upstate Medical University Syracuse NY USA

Faculty of Biology Medicine and Health University of Manchester Manchester UK

IBD Center IRCCS Humanitas Research Hospital Rozzano Milan Italy

IBD MOM Unit Digestive Diseases Institute Shaare Zedek Medical Center affiliated with the Hebrew University Jerusalem Israel

IBD Unit San Filippo Neri Hospital Rome Italy

Moscow Clinical Scientific Center named after A S Loginov Moscow Russia

National Medical Research Center of Coloproctology named after A N Ryzhykh Moscow Russia

Research Institute of Health Organization and Medical Management Moscow Russia

J Crohns Colitis. 2025 May 8;19(5):jjaf071. doi: 10.1093/ecco-jcc/jjaf071. PubMed

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