Proton pump inhibitor use and recurrent Clostridium difficile-associated disease: a case-control analysis matched by propensity score.
OBJECTIVE
Clostridium difficile has been increasingly diagnosed in hospitalized patients. An association between proton pump inhibitors (PPIs) use and Clostridium difficile-associated disease (CDAD) and between recurrent CDAD has been suggested. The aim of this study is to investigate whether PPI use is associated with the development of recurrent CDAD.


METHODS
This was a retrospective case-control study of patients with CDAD at Yeungnam University Medical Center, seen from January 2004 to December 2008. C. difficile infection was diagnosed by the presence of C. difficile toxin in the stool. Those with recurrent disease were matched with nonrecurrent controls using multivariate matched sampling methods that incorporated the propensity score.


RESULTS
Recurrent CDAD developed in 28 (14.1%) of the 198 patients with diarrhea and positive C. difficile stool toxin assays. Multivariate analysis of the total population of recurrent versus nonrecurrent CDAD revealed that additional use of non-C. difficile antimicrobial therapy (concomitant with the treatment or after or both), poor response to therapy with metronidazole or vancomycin, and recent gastrointestinal surgery were risk factors for recurrent CDAD. We were able to match 21 recurrent CDAD subjects with 21 without recurrent CDAD. Among the matched patients only PPI use was associated with recurrent CDAD (ie, 47.6% vs. 4.8%, P=0.004 for recurrent vs. nonrecurrent CDAD, respectively).


CONCLUSIONS
Among the matched patient groups, only PPI therapy was associated with recurrent CDAD. Prospective studies are needed to clarify whether avoidance of PPIs or specific cotherapies will reduce the incidence of recurrent C. difficile-associated diarrhea.
Department of Internal Medicine, CHA University College of Medicine, CHAUM Medical Center, Seoul, Korea.
Yong Gil
YG
Kim
David Y
DY
Graham
Byung Ik
BI
Jang
D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016022:Case-Control Studies; D016360:Clostridioides difficile; D004761:Enterocolitis, Pseudomembranous / Q000139:chemically induced* / Q000175:diagnosis / Q000382:microbiology / Q000517:prevention & control; D005260:Female; D005764:Gastroesophageal Reflux / Q000188:drug therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D054328:Proton Pump Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D013276:Stomach Ulcer / Q000188:drug therapy
D000900:Anti-Bacterial Agents; D054328:Proton Pump Inhibitors