Increased risk of recurrent C. difficile infection associated with PPIs

January 01, 0001

Increased risk of recurrent C. difficile infection associated with PPIs

This study was a retrospective cohort study by US authors using administrative databases of the New England Veterans Healthcare System from October 2003 through September 2008. They identified 1166 inpatients and outpatients with metronidazole- or vancomycin hydrochloride-treated incident Clostridium difficile infection (CDI), of whom 527 (45.2%) received oral PPIs within 14 days of diagnosis and 639 (54.8%) did not. They determined the hazard ratio (HR) for recurrent CDI, defined by a positive toxin finding in the 15 to 90 days after incident CDI.

They found: "Recurrent CDI was more common in those exposed to PPIs than in those not exposed (25.2% vs 18.5%). Using Cox proportional survival methods, we determined that the adjusted HR of recurrent CDI was greater in those exposed to PPIs during treatment (1.42, significant). Risks among exposed patients were highest among those older than 80 years (HR, 1.86) and those receiving antibiotics not targeted to C difficile during follow-up (HR, 1.71)."

The authors concluded: "Proton pump inhibitor use during incident CDI treatment was associated with a 42% increased risk of recurrence. Our findings warrant further studies to examine this association and careful consideration of the indications for prescribing PPIs during treatment of CDI."

This study is sufficient to question use of PPIs for patients after initial episode of C. difficile infection.

For the full abstract, click here.

Arch Intern Med 170(9):772-778, 10 May 2010 © 2010 to the American Medical Association
Proton Pump Inhibitors and Risk for Recurrent Clostridium difficile Infection. Amy Linsky, Kalpana Gupta, Elizabeth V. Lawler, Jennifer R. Fonda, John A. Hermos. Correspondence to Dr. Linsky: [email protected]

Category: D. Digestive. Keywords: Clostridium difficile, recurrent infection, proton pump inhibitors, PPIs, antibiotic therapy, retrospective cohort study, journal watch.
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 1 June 2010

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.

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