title: 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.
  
  
  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; P<.001) and more likely to have severe (34.2% vs 23.6%; P=.03) or severe-complicated (4.4% vs 2.6% CDI; P=.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 severe-complicated CDI. In addition, no association between acid suppression and treatment failure or CDI recurrence was found.
  
  
  CONCLUSIONS
  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.
authors: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, USA.
authors: Sahil
authors: S
authors: Khanna
authors: Scott L
authors: SL
authors: Aronson
authors: Patricia P
authors: PP
authors: Kammer
authors: Larry M
authors: LM
authors: Baddour
authors: Darrell S
authors: DS
authors: Pardi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D016360:Clostridioides difficile / Q000302:isolation & purification; D015897:Comorbidity; D004761:Enterocolitis, Pseudomembranous / Q000188:drug therapy / Q000453:epidemiology*; D005260:Female; D005744:Gastric Acid / Q000378:metabolism*; D006635:Histamine H2 Antagonists / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D054328:Proton Pump Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D012008:Recurrence; D012189:Retrospective Studies; D012720:Severity of Illness Index; D017211:Treatment Failure; D055815:Young Adult
chemical_list: D006635:Histamine H2 Antagonists; D054328:Proton Pump Inhibitors