title: Clostridium difficile infection in the community: are proton pump inhibitors to blame?
abstract: Once a nosocomial disease, Clostridium difficile infection (CDI) now appears frequently in the community in the absence of exposure to antibiotics. Prior studies have shown that patients with community-acquired CDI are younger, more likely to be female, and have fewer comorbidities compared to patients with hospital-associated CDI. Because most studies of CDI are hospital-based, comparatively little is known about community-acquired CDI. The recent study by Chitnis has received widespread attention because it used active surveillance to capture all cases of community-acquired CDI within a large population and assessed key risk factors. The authors found that low-level healthcare exposure and proton pump inhibitor use were common among those with non-antibiotics associated, community-acquired CDI. In this commentary, we discuss the changing epidemiology of community-acquired CDI and the evidence basis for the controversial association between proton pump inhibitors and community-acquired CDI.
authors.affiliation: Daniel E Freedberg, Julian A Abrams, Division of Digestive and Liver Diseases, Columbia University Medical Center, New York, NY 10032, United States.
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Freedberg
authors.forename: Julian A
authors.initials: JA
authors.lastname: Abrams
mesh_terms: D016360:Clostridioides difficile / Q000302:isolation & purification*; D004761:Enterocolitis, Pseudomembranous / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D011159:Population Surveillance
keywords: Anti-bacterial agents; Clostridium difficile; Disease outbreaks; Epidemics; Pharmacoepidemiology; Proton pump inhibitors; Pseudomembranous enterocolitis; Public health