Proton pump inhibitors as a risk factor for recurrence of Clostridium-difficile-associated diarrhea

Aim: To investigate the risk factors for Clostridium-difficile-associated diarrhea (CDAD) recurrence, and its relationship with proton pump inhibitors (PPIs). METHODS: Retrospective data of 125 consecutive hospitalized patients diagnosed with CDAD between January 2006 and December 2007 were collected by medical chart review. Collected data included patient characteristics at baseline, underlying medical disease, antibiotic history before receiving a diagnosis of CDAD, duration of hospital stay, severity of CDAD, concurrent treatment with PPIs, laboratory parameters, response to CDAD therapy, and recurrence of disease within 90 d of successful treatment. Various clinical and laboratory parameters were compared in patients in whom CDAD did or did not recur. RESULTS: Of the 125 patients (mean age, 67.6 +/- 13.9 years) that developed CDAD, 98 (78.4%) did not experience recurrence (non-recurrent group) and 27 (21.6%) experienced one or more recurrences (recurrent group). Prior to the development of CDAD, 96% of the 125 patients were prescribed antibiotics, and 56 (44.8%) of the patients received PPIs. Age older than 65 years (P = 0.021), feeding via nasogastric tube (NGT) (P = 0.045), low serum albumin level (P = 0.025), and concurrent use of PPIs (P = 0.014) were found to be risk factors for CDAD recurrence by univariate analysis. However, sex, length of hospital stay, duration and type of antibiotics used, severity of disease, leukocyte count and C-reactive protein (CRP) were not associated with risk of CDAD recurrence. On multivariate analysis, the important risk factors were advanced age (> 65 years, adjusted OR: 1.32, 95% CI: 1.12-3.87, P = 0.031), low serum albumin level (< 2.5 g/dL, adjusted OR: 1.85, 95% CI: 1.35-4.91, P = 0.028), and concurrent use of PPIs (adjusted OR: 3.48, 95% CI: 1.64-7.69, P = 0.016). CONCLUSION: Advanced age, serum albumin level < 2.5 g/dL, and concomitant use of PPIs were found to be significant risk factors for CDAD recurrence.