title: Does Alkaline Colonic pH Predispose to Clostridium difficile Infection?
abstract: OBJECTIVE
  Clostridium difficile caused nearly 500,000 infections and was associated with approximately 29,000 deaths in 2011, according to data from the Centers for Disease Control and Prevention. C. difficile is a bacterium that causes diarrhea and, often, severe illness in healthcare facilities, as well as the community. Our objective was to determine whether alkaline colonic pH predisposes to colonization and infection with C. difficile.
  
  
  METHODS
  A total of 228 patients with diarrhea and/or abdominal pain, leukocytosis, and fever were included. Stool pH was measured, and C. difficile antigen and toxin in stool were detected.
  
  
  RESULTS
  Of 228 patients, 30 (13.2%) tested positive for C. difficile (antigen+/toxin+) and 171 (75%) were C. difficile negative (antigen-/toxin-). Of 171 patients who tested negative, 93 (54.4%) had stool pH >7.0 and 78 (45.6%) had pH ≤7.0. Among the 30 patients who tested positive, 26 (86.7%) had stool pH >7.0 (P = 0.002). Among the 27 colonized patients (antigen+/toxin-), 12 (44.4%) had stool pH >7.0 (P = 0.34). For all patients with stool pH ≤7.0, 96% tested negative for C. difficile infection (P = 0.002).
  
  
  CONCLUSIONS
  A strong association between C. difficile infection and alkaline stool pH was found.
authors: From the Department of Internal Medicine and the Division of Infectious Diseases, Maimonides Medical Center, Brooklyn, New York.
authors: Purba
authors: P
authors: Gupta
authors: From the Department of Internal Medicine and the Division of Infectious Diseases, Maimonides Medical Center, Brooklyn, New York.
authors: Stanley
authors: S
authors: Yakubov
authors: From the Department of Internal Medicine and the Division of Infectious Diseases, Maimonides Medical Center, Brooklyn, New York.
authors: Kevin
authors: K
authors: Tin
authors: From the Department of Internal Medicine and the Division of Infectious Diseases, Maimonides Medical Center, Brooklyn, New York.
authors: Diego
authors: D
authors: Zea
authors: From the Department of Internal Medicine and the Division of Infectious Diseases, Maimonides Medical Center, Brooklyn, New York.
authors: Olga
authors: O
authors: Garankina
authors: From the Department of Internal Medicine and the Division of Infectious Diseases, Maimonides Medical Center, Brooklyn, New York.
authors: Monica
authors: M
authors: Ghitan
authors: From the Department of Internal Medicine and the Division of Infectious Diseases, Maimonides Medical Center, Brooklyn, New York.
authors: Edward K
authors: EK
authors: Chapnick
authors: From the Department of Internal Medicine and the Division of Infectious Diseases, Maimonides Medical Center, Brooklyn, New York.
authors: Peter
authors: P
authors: Homel
authors: From the Department of Internal Medicine and the Division of Infectious Diseases, Maimonides Medical Center, Brooklyn, New York.
authors: Yu Shia
authors: YS
authors: Lin
authors: From the Department of Internal Medicine and the Division of Infectious Diseases, Maimonides Medical Center, Brooklyn, New York.
authors: Michael M
authors: MM
authors: Koegel
mesh_terms: D000368:Aged; D016360:Clostridioides difficile / Q000502:physiology; D003106:Colon / Q000382:microbiology* / Q000503:physiopathology; D003967:Diarrhea / Q000209:etiology / Q000382:microbiology / Q000503:physiopathology; D004761:Enterocolitis, Pseudomembranous / Q000209:etiology*; D005243:Feces / Q000382:microbiology; D005260:Female; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007419:Intestinal Secretions / Q000382:microbiology / Q000502:physiology*; D008297:Male; D011446:Prospective Studies; D012307:Risk Factors