Association of proton-pump inhibitors with outcomes in Clostridium difficile colitis.
OBJECTIVE
The role of concurrent use of proton-pump inhibitors (PPIs) in the outcomes of treatment for Clostridium difficile colitis was studied. Methods. The records of inpatients at a large Veterans Affairs medical center in whom C. difficile colitis was diagnosed between June 2004 and July 2005 were retrospectively reviewed. Data collected included patient characteristics at baseline, antibiotic therapy prescribed before and during therapy for C. difficile colitis, concurrent treatment with a PPI, response to therapy for C. difficile colitis, and recurrence of the disease in the 90 days after symptoms resolved. Outcomes of therapy were classified as cures, treatment failures, or disease recurrences.


RESULTS
A total of 140 patients (138 men and 2 women) were included in the study. Ninety-seven (69%) of patients received a PPI and 43 (31%) did not. Of patients receiving a PPI, 37 (38%) were cured of C. difficile colitis, 20 (21%) did not respond to therapy, and 40 (41%) had disease recurrence. Among the non-PPI patients, 27 (63%) were cured, 9 (21%) did not respond, and 7 (16%) had recurrence. Patients receiving PPIs were 4.17 times as likely to have recurrence as their counterparts who did not.


CONCLUSIONS
PPI therapy was associated with an increased risk of recurrent C. difficile colitis.
Cadle
Richard M
RM
Michael E. DeBakey Veterans Affairs Medical Center (MEDVAMC), Houston, TX 77030, USA. cadle.richardmark@med.va.gov
Mansouri
Mohammad D
MD
Logan
Nancy
N
Kudva
Denise R
DR
Musher
Daniel M
DM
D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016360:Clostridioides difficile / Q000187:drug effects*; D015897:Comorbidity; D004359:Drug Therapy, Combination; D004761:Enterocolitis, Pseudomembranous / Q000188:drug therapy* / Q000453:epidemiology / Q000473:pathology; D005260:Female; D006787:Hospitals, Veterans; D006801:Humans; D015994:Incidence; D008297:Male; D016347:Medical Records Systems, Computerized; D008875:Middle Aged; D054328:Proton Pump Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D012008:Recurrence; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013781:Texas; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D054328:Proton Pump Inhibitors