Recurrence and death after Clostridium difficile infection: gender-dependant influence of proton pump inhibitor therapy

Abstract

GoalsTo determine whether patients with a pre-existing PPI treatment had a higher risk of poor evolution (recurrence or death) when diagnosed with a toxicogenic Clostridium difficile digestive infection.BackgroundPrevious studies identified pump proton inhibitor (PPI) prescription as a risk factor for C. difficile infection. The influence of PPI on the outcome of C. difficile infection is controversial.StudyThis was a retrospective monocentric cohort study. All cases of patients in our center with a symptomatic infection by a toxicogenic C. difficile strain during the years 2012 and 2013 were retrospectively analyzed. The primary endpoint was the occurrence of a recurrence or C. difficile infection -related death within 2 months after diagnosis.Results373 patients were included in this study (198 men and 175 women), with a mean age of 70.1 ± 18.6 years (2–100 years). Fourteen (3.7 %) patients died secondarily to C. difficile infection (median survival time 5 days), and 88 (23.6 %) experienced recurrence (after a median delay of 30 days). One hundred and ninety eight (53.1 %) patients were already receiving PPI at the time of the C. difficile infection (including 156 patients with a prescription >1 month). When analyzing separately men and women, male patients were more likely to experience recurrence or death in case of pre-existing PPI prescription [HR = 2.32 (1.26–4.27)]; this was not observed in female patients [HR = 0.62 (0.31–1.22)].ConclusionsPre-existing PPI therapy may increase the risk of recurrence or death in male patients with a toxicogenic C. difficile infection. PPI risk–benefit ratio should be carefully assessed.

Proton pump inhibitor use and risk for recurrent Clostridioides difficile infection: a systematic review and meta-analysis

“…In total, 18 studies were included for qualitative review and 16 studiesdten caseecontrol studies [15e25] and six cohort studies [3,26e30]dwere included in the meta-analysis. Two studies [31,32] contained insufficient data to calculate a measure of association and results are described qualitatively.…”

“…Two additional studies used metrics other than the odds ratio; in these the crude data were not available. Dos Santos-Schaller et al [31] noted an increased hazard of experiencing the composite outcome of CDI recurrence or death in male patients with preexisting prescription for a PPI (HR 2.32, 95%CI 1.26e4.27). A lower quality study [32] observed that PPI use was correlated with a decreased risk of recurrent CDI on univariate analyses (p 0.0006).…”

Epidemiology and outcomes of Clostridium difficile infection among hospitalised patients: results of a multicentre retrospective study in South Africa

“…Another is a study that reported male patients with proton pump inhibitor use have a higher risk of CDI mortality. 20 21 Tuberculosis incidence is higher in men in South Africa (male 226 000 vs female 154 000) and a tendency for men to present for healthcare later in their disease course has been reported in South Africa and globally. 22 23 Despite the propensity for CDI-related mortality in men, previous studies in high-resource settings report women are more likely to have CDI.…”

Traditional Chinese Medicine QPYF as Preventive Treatment for Clostridium difficile Associated Diarrhea in a Mouse Model

“…The search for alternative treatments against CDAD is becoming more and more urgent [16]. TCM has a history of thousands of years, and it has its own unique theory on CDAD.…”