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Proton pump inhibitor therapy is a risk factor for Clostridium difficile-associated diarrhoea

  1. K. A. YEARSLEY1,
  2. L. J. GILBY1,
  3. A. V. RAMADAS1,
  4. E. M. KUBIAK2,
  5. D. L. FONE3,
  6. M. C. ALLISON1

Article first published online: 25 JUL 2006

DOI: 10.1111/j.1365-2036.2006.03015.x

Issue

Alimentary Pharmacology & Therapeutics

Alimentary Pharmacology & Therapeutics

Volume 24, Issue 4, pages 613–619, August 2006

Additional Information

How to Cite

YEARSLEY, K. A., GILBY, L. J., RAMADAS, A. V., KUBIAK, E. M., FONE, D. L. and ALLISON, M. C. (2006), Proton pump inhibitor therapy is a risk factor for Clostridium difficile-associated diarrhoea. Alimentary Pharmacology & Therapeutics, 24: 613–619. doi: 10.1111/j.1365-2036.2006.03015.x

Author Information

  1. 1

    Departments of Adult Medicine

  2. 2

    Microbiology, Royal Gwent Hospital, Newport, South Wales

  3. 3

    Department of Epidemiology, Statistics and Public Health, Centre for Health Sciences Research, School of Medicine, Cardiff University, Heath Park, Cardiff, UK

*Dr M. C. Allison, Department of Adult Medicine, Royal Gwent Hospital, Newport NP20 2UB, South Wales, UK. E-mail: miles.allison@gwent.wales.nhs.uk

Publication History

  1. Issue published online: 25 JUL 2006
  2. Article first published online: 25 JUL 2006
  3. Publication data Submitted 25 January 2006 First decision 2 February 2006 Resubmitted 18 April 2006 Resubmitted 15 May 2006 Accepted 31 May 2006

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Summary

Background

Inhibition of gastric acid removes a defence against ingested bacteria and spores, increasing the risk of some forms of gastroenteritis. Previous studies investigating a possible link between acid suppression therapy and Clostridium difficile-associated diarrhoea have reported conflicting results.

Aim

To investigate whether acid suppression therapy is associated with an increased risk of C. difficile-associated diarrhoea.

Methods

Prospective case–control study of 155 consecutive in-patients with C. difficile-associated diarrhoea.

Results

Antibiotics had been received by 143 (92%) of the C. difficile-associated diarrhoea group and 76 (50%) of the controls during the preceding 3 months. Among those receiving antibiotics, 59 (41%) of the C. difficile-associated diarrhoea group had also received acid suppression, compared with 21 (28%) of controls (OR 1.84, CI 1.01, 3.36, χ2 = 4.0, P = 0.046). Among the entire C. difficile-associated diarrhoea group 64 (41%) had received acid suppression compared with 40 (26%) of controls (OR 1.99, CI 1.19, 3.31, χ2 = 7.9, P = 0.005). Logistic regression analyses found that C. difficile-associated diarrhoea was independently associated with: antibiotic use (OR 13.1, 95% CI: 6.6, 26.1); acid suppression therapy (OR 1.90, 95% CI: 1.10, 3.29); and female sex (OR 1.79, 95% CI: 1.06, 3.04).

Conclusions

The risk of C. difficile-associated diarrhoea in hospitalized patients receiving antibiotics may be compounded by exposure to proton pump inhibitor therapy.

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