Gastric Acid Suppression and Outcomes in Clostridium difficile Infection: A Population-Based Study

Abstract

Objective: To evaluate the association of gastric acid suppression medications, including proton pump inhibitors and histamine type 2 blockers, with outcomes in patients with Clostridium difficile infection (CDI) in a population-based cohort. Patients and Methods: To understand the association between acid suppression and outcomes in patients with CDI, we conducted a population-based study in Olmsted County, Minnesota, from January 1, 1991, through December 31, 2005. We compared demographic data and outcomes, including severe, severe-complicated, and recurrent CDI and treatment failure, in a cohort of patients with CDI who were treated with acid suppression medications with these outcomes in a cohort with CDI that was not exposed to acid-suppressing agents. Results: Of 385 patients with CDI, 36.4% were undergoing acid suppression (23.4% with proton pump inhibitors, 13.5% with histamine type 2 blockers, and 0.5% with both). On univariate analysis, patients taking acid suppression medications were significantly older (69 vs 56 years; PϽ.001) and more likely to have severe (34.2% vs 23.6%; Pϭ.03) or severecomplicated (4.4% vs 2.6% CDI; Pϭ.006) infection than patients not undergoing acid suppression. On multivariable analyses, after adjustment for age and comorbid conditions, acid suppression medication use was not associated with severe or severecomplicated CDI. In addition, no association between acid suppression and treatment failure or CDI recurrence was found. Conclusion: In this population-based study, after adjustment for age and comorbid conditions, patients with CDI who underwent acid suppression were not more likely to experience severe or severe-complicated CDI, treatment failure, or recurrent infection.

Factors Associated With Complications ofClostridium difficileInfection in a Multicenter Prospective Cohort

“…This is consistent with other studies using a similar definition for C. difficile complication [6,9,10]. The population was mainly hospitalized elderly patients with numerous comorbidities, frequent exposure to antimicrobials, acid suppression, and infected predominantly with the R027 strain.…”

Clostridium difficile Infection: New Insights Into Management

“…49,50 Furthermore, studies have found that after controlling for important confounders, the use of PPIs and histamine 2 blockers was not associated with the risk of CDI 51 or adverse outcomes from CDI. 52 Thus, it is not clear whether use of acid-suppressing drugs is an independent risk factor for CDI, 53 although the US Food and Drug Administration (FDA) has recently issued a warning that PPIs are associated with an increased risk of CDI. A summary of risk factors for CDI is given in Table 1.…”

Clinical update for the diagnosis and treatment ofClostridium difficileinfection

“…Despite these results, the most recent studies offer conflicting viewpoints as to the association between PPI use and increased risk of C. difficile infection. These studies showed that while univariate analysis may show a statistically significant relationship between PPI use and CDI, multivariable analysis reveals no significant relationship [27][28][29] . Further, the most recent review on detection, prevention and treatment of C. difficile does not include restriction or avoidance of PPIs in the recommendations for prevention of C. difficile infection [30] , nor is this recommended by multi society clinical practice guidelines [31] .…”