Proton pump inhibitors are a risk factor for C. difficile reinfection

The risk factors for CDAD recurrence have been described as advanced age, severe underlying disease such as renal impairment, multiple episodes of previous CDAD infection, and high white blood cell counts. Recent literature suggests that the use of gastric acid suppressive agents, especially proton pump inhibitors (PPIs) is associated with CDAD recurrence, although results appear to be conflicting.

A research article to be published on July 28, 2010 in the World Journal of Gastroenterology addresses this question. This research led by Professor Lee from Seoul National University Boramae Hospital investigated the risk factors for CDAD recurrence and the relationship between the use of PPIs and CDAD recurrence. Of the 125 patients that developed CDAD, 98 (78.4%) patients did not experience recurrence and 27 (21.6%) experienced one or more episodes of recurrence.

Age > 65 years, low serum albumin level < 2.5 g/dL, and use of PPIs were found to be risk factors for CDAD recurrence. However, sex, length of hospital stay, duration and type of antibiotics used, severity of disease, leukocyte count and C-reactive protein were not associated with risk of CDAD recurrence.

Of these risk factors, the use of PPIs is a modifiable risk factor, and thus, it is appropriate to review constantly the necessity for concomitant use of PPIs in patients with CDAD. Prevention of unwarranted PPI therapy may be helpful in reducing the risk of CDAD recurrence, and additional larger studies are needed to understand better the relationship between PPI use and CDAD recurrence.

Reference: Kim JW, Lee KL, Jeong JB, Kim BG, Shin S, Kim JS, Jung HC, Song IS. Proton pump inhibitors as a risk factor for recurrence of Clostridium-difficile-associated diarrhea. World J Gastroenterol 2010; 16(28): 3573-3577

http://www.wjgnet.com/1007-9327/full/v16/i28/3573.htm

Correspondence to: Kook Lae Lee, MD, PhD, Associate Professor, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Seoul National University Boramae Hospital, Seoul National University College of Medicine, 425, Shindaebang-Dong, Dongjak-Gu, Seoul 156-707, South Korea. kllee@brm.co.kr

Telephone: +82-2-8702212 Fax: +82-2-8703866

World Journal of Gastroenterology (WJG), a leading international journal in gastroenterology and hepatology, has established a reputation for publishing first class research on esophageal cancer, gastric cancer, liver cancer, viral hepatitis, colorectal cancer, and H. pylori infection and provides a forum for both clinicians and scientists. WJG has been indexed and abstracted in Current Contents/Clinical Medicine, Science Citation Index Expanded (also known as SciSearch) and Journal Citation Reports/Science Edition, Index Medicus, MEDLINE and PubMed, Chemical Abstracts, EMBASE/Excerpta Medica, Abstracts Journals, Nature Clinical Practice Gastroenterology and Hepatology, CAB Abstracts and Global Health. ISI JCR 2009 IF: 2.092. WJG is a weekly journal published by WJG Press. The publication dates are the 7th, 14th, 21st, and 28th day of every month. WJG is supported by The National Natural Science Foundation of China, No. 30224801 and No. 30424812, and was founded with the name of China National Journal of New Gastroenterology on October 1, 1995, and renamed WJG on January 25, 1998.

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