One Risk Factor For C. difficile Reinfection is Proton Pump Inhibitors

Main Category: Infectious Diseases / Bacteria / Viruses
Also Included In: GastroIntestinal / Gastroenterology
Article Date: 03 Aug 2010 - 3:00 PDT


The risk factors for CDAD recurrence have been described as advanced age, severe underlying disease such as renal impairment, multiple episodes of previous CDAD infection, and high white blood cell counts. Recent literature suggests that the use of gastric acid suppressive agents, especially proton pump inhibitors (PPIs) is associated with CDAD recurrence, although results appear to be conflicting.

A research article published in the World Journal of Gastroenterology addresses this issue. This research led by Professor Lee from Seoul National University Boramae Hospital investigated the risk factors for CDAD recurrence and the relationship between the use of PPIs and CDAD recurrence. Of the 125 patients that developed CDAD, 98 (78.4%) patients did not experience recurrence and 27 (21.6%) experienced one or more episodes of recurrence.

Age > 65 years, low serum albumin level < 2.5 g/dL, and use of PPIs were found to be risk factors for CDAD recurrence. However, sex, length of hospital stay, duration and type of antibiotics used, severity of disease, leukocyte count and C-reactive protein were not associated with risk of CDAD recurrence.

Of these risk factors, the use of PPIs is a modifiable risk factor, and thus, it is appropriate to review constantly the necessity for concomitant use of PPIs in patients with CDAD. Prevention of unwarranted PPI therapy may be helpful in reducing the risk of CDAD recurrence, and additional larger studies are needed to understand better the relationship between PPI use and CDAD recurrence.

Reference:
Kim JW, Lee KL, Jeong JB, Kim BG, Shin S, Kim JS, Jung HC, Song IS. Proton pump inhibitors as a risk factor for recurrence of Clostridium-difficile-associated diarrhea. World J Gastroenterol 2010; 16(28): 3573-3577

Source:
Lin Tian
World Journal of Gastroenterology

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