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» LymeNet Flash » Questions and Discussion » Medical Questions » Clostridium Difficile Increase/PPI's as cause?

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Author Topic: Clostridium Difficile Increase/PPI's as cause?
MarsyNY
LymeNet Contributor
Member # 7766

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http://www.cmaj.ca/pressrelease/pg745.pdf

http://phx.corporate-ir.net/phoenix.zhtml?c=92320&p=irol-researchNewsArticle&ID=910288&highlight=

Posts: 465 | From New York, NY | Registered: Aug 2005  |  IP: Logged | Report this post to a Moderator
treepatrol
Honored Contributor (10K+ posts)
Member # 4117

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Background: The association between the use of proton pump
inhibitors and the risk of Clostridium difficile-associated disease
(CDAD) is controversial. In this study we re-examined a
previously reported association between the use of proton
pump inhibitors and the development of community-acquired
CDAD, this time using an alternative case definition of the
disease.
Methods: We performed a case-control study of community-
acquired CDAD using a United Kingdom clinical research
database. Patients receiving oral vancomycin therapy
were identified as having CDAD, the only indication for this
drug. Each case subject was matched with up to 10 control
subjects. Neither the cases nor the controls had been admitted
to hospital in the year before the date of the vancomycin
prescription (index date). Conditional logistic regression
analysis was used to adjust for key covariates.
Results: We identified 317 cases of community-acquired
CDAD treated with oral vancomycin therapy and 3167
matched control subjects. Exposure to a proton pump inhibitor
in the 90 days before the index date was associated
with an increased risk of CDAD (odds ratio [OR] 3.5, 95%
confidence interval [CI] 2.3-5.2). Antibiotic exposure in the
90 days before the index date was also a significant risk factor
for community-acquired CDAD (OR 8.2, 95% CI 6.1-11.0),
even though 45% of the case subjects had not received a
prescription for an antibiotic during that period. Certain comorbidities,
in particular renal failure, inflammatory bowel
disease and malignant disease, as well as prior methicillinresistant
Staphylococcus aureus infection, were also associated
with an increased risk.
Interpretation: Proton pump inhibitor use was associated
with an increased risk of community-acquired CDAD, when
cases were defined by receipt of prescription for oral vancomycin
therapy. Prior antibiotic exposure was also a
significant risk factor, but a significant proportion of the
patients with community-acquired CDAD had no such
exposure.
Abstract
CMAJ 2006;175(7):745-8

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