title: Non-steroidal anti-inflammatory drugs and the risk of Clostridium difficile-associated disease.
abstract: OBJECTIVE
  Several case reports have linked diclofenac, a non-steroidal anti-inflammatory drug (NSAID), with Clostridium difficile associated disease (CDAD). We assessed whether NSAID use in general, and diclofenac use in particular, is associated with an increased risk of CDAD.
  
  
  METHODS
  We used the United Kingdom's General Practice Research Database (GPRD) to conduct a population-based case-control study. All cases of CDAD occurring between 1994 and 2005 were identified and were matched to 10 controls each. Conditional logistic regression was used to estimate the odds ratio of CDAD associated with current NSAID use, adjusting for covariates.
  
  
  RESULTS
  We identified 1360 CDAD cases and 13 072 controls. We found an increased risk of CDAD associated with diclofenac (adjusted odds ratio (RR) 1.35, 95% confidence interval (CI) 1.10, 1.67). We did not observe an increased risk of CDAD with use of any other NSAID. No dose-response for diclofenac exposure was found. When we analyzed only patients who were not hospitalized in the year before the index date, we found diclofenac to have a similar effect on CDAD risk (adjusted RR 1.43, 95% CI 1.11, 1.84).
  
  
  CONCLUSIONS
  Diclofenac use is associated with a modest increase in the risk of CDAD. In patients at risk of CDAD, other NSAIDs could be prescribed.
authors.affiliation: Division of Plastic Surgery, Centre Hospitalier de l'Universite de Montreal, Montreal, Canada.
authors.forename: Daniel
authors.initials: D
authors.lastname: Suissa
authors.forename: Joseph A C
authors.initials: JA
authors.lastname: Delaney
authors.forename: Sandra
authors.initials: S
authors.lastname: Dial
authors.forename: Paul
authors.initials: P
authors.lastname: Brassard
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D016022:Case-Control Studies; D016360:Clostridioides difficile / Q000472:pathogenicity*; D003015:Clostridium Infections / Q000139:chemically induced* / Q000453:epidemiology / Q000382:microbiology; D004008:Diclofenac / Q000009:adverse effects*; D058006:General Practice; D006801:Humans; D016015:Logistic Models; D016017:Odds Ratio; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D006113:United Kingdom
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D004008:Diclofenac