Authors: YEARSLEY, K. A.¹; GILBY, L. J.¹; RAMADAS, A. V.¹; KUBIAK, E. M.²; FONE, D. L.³; ALLISON, M. C.¹

Source: Alimentary Pharmacology & Therapeutics, Volume 24, Number 4, August 2006 , pp. 613-619(7)

Publisher: Wiley-Blackwell

Abstract:

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.

Document Type: Research article

DOI: http://dx.doi.org/10.1111/j.1365-2036.2006.03015.x

Affiliations: 1: Adult Medicine 2: Microbiology, Royal Gwent Hospital, Newport, South Wales 3: Department of Epidemiology, Statistics and Public Health, Centre for Health Sciences Research, School of Medicine, Cardiff University, Heath Park, Cardiff, UK

Publication date: 2006-08-01

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