No link between nosocomial C. difficile recurrence, concurrent PPI use/infection treatment

October 9, 2013

Hospitalized patients with Clostridium difficile infection were not at increased risk for recurrence when treated with proton pump inhibitors concurrently with infection therapy in a recent study.

Researchers evaluated data from 894 adult patients who developed incident C. difficile infection (CDI) while hospitalized between Dec. 1, 2009 and June 30, 2012. Recurrence was defined as a positive stool test within 15 to 90 days of the initial diagnostic test. Proton pump inhibitors (PPI) administered in-hospital along with (CDI) treatment was defined as the primary exposure.

Participants received concurrent PPI and CDI treatment in 62% of cases, and recurrence occurred in 23% of the cohort. Patients receiving PPI therapy were more likely to be receiving antibiotics (86% of cases vs. 52%) and immunosuppressants (47% vs. 15%) and require an ICU stay (53% vs. 27%), and had longer hospital stays (median, 17 days vs. 8 days) than nonrecipients (P<.01 for all). Ninety-day mortality was more common among patients who experienced recurrence (32% vs. 25%; P=.03).

Factors associated with recurrence on multivariate analysis included advanced age (HR=1.02; 95% CI, 1.01-1.03 per year), more comorbidities (HR=1.09; 95% CI, 1.04-1.14 per point on the Charlson comorbidity index) and black race (HR=1.66; 95% CI, 1.05-2.63). No association was observed between infection recurrence and concurrent PPI/CDI therapy (HR=0.82; 95% CI, 0.58-1.16), or between increased dose or duration of PPI treatment.

Sensitivity analysis in a subgroup of 635 patients who survived a 90-day follow-up period after initially testing positive for CDI indicated no association between PPI use and CDI recurrence (HR=0.87; 95% CI, 0.6-1.28).

“Our primary results are best applied to populations that resemble the patients in our study — patients in tertiary care settings with a high degree of illness and multiple comorbidities,” the researchers wrote. “Although hospitalized patients frequently receive PPIs without indication, in-hospital administration of PPIs does not increase the risk of CDI recurrence. Future studies should test interventions to prevent CDI recurrence among high-risk inpatients.”