Continuous PPI use associated with C. difficile recurrences

Recurrences of Clostridium difficile were significantly more common among patients who continuously took proton-pump inhibitors (PPIs) than among those who didn't, a recent study found.

The retrospective cohort study included 754 patients at 2 Canadian hospitals who developed health care-associated C. difficile infection in 2010 to 2013 and survived for a minimum of 15 days after their initial episode. Continuous PPI use was common (60.7% of patients), and a record review showed that only 47.1% of these prescriptions were evidence-based. The study was published by JAMA Internal Medicine on March 2.

The patients taking PPIs had a 28.8% risk of recurrent C. difficile, compared to 20.6% in nonusers (P=0.007), and they were more likely to die within 15 to 90 days of the initial episode (10.3% vs. 4.7%; P=0.007). According to a multivariable Cox proportional hazards model, the hazard ratio of recurrence associated with PPI use was 1.5 (95% CI, 1.1 to 2.0), which was equal to age older than 75 years (1.5 [95% CI, 1.1 to 2.0]) and greater than the hazard associated with antibiotic reexposure or longer length of stay (1.3 [95% CI, 0.9 to 1.7] and 1.003 per day [95% CI, 1.002 to 1.004], respectively).

The authors noted that PPIs were discontinued in only 3 of the patients with C. difficile. They suggested that clinicians should almost certainly stop non-evidence-based PPI prescriptions at the time of C. difficile diagnosis. “The cost of PPI discontinuation is negligible, and tapering the PPI dosage before discontinuation may help to curb any complications such as symptoms of rebound hyperacidity,” they wrote.

Although previous research has looked at the association between PPI use and C. difficile, few studies have analyzed the drugs' relationship with disease recurrences. Preventing C. difficile recurrences by avoiding PPIs would reduce costs for the health care system, even as new treatments for C. difficile are being developed, the authors said.