RISK OF RECURRENCE OF CLOSTRIDIUM
DIFFICILE INFECTION WITH PPI USE
Nilofar Rahman, MD
CLOSTRIDIUM DIFFICILE ORGANISM
 Identified in 1978
 “J strain”
 B1/NAP1/027 strain
INCIDENT RATES IF C. DIFF. INFECTION
EPIDEMIOLOGY OF C. DIFF INFECTION
RISK FACTORS FOR RECURRENCE OF CDI
 Advanced age
 Non- CDI targeted antibiotic exposure
 Longer hospital stay
 Inadequate antitoxin-antibody response
 Concomitant use of PPIs
STUDY DONE BY LINSKY ET AL.
STUDY DESIGN
1549 Incident c. diff toxin
1408 treated with oral metronidazole or
vancomycin
1166 treated within 3 d before or after
index CDI
527 PPI exposure
639 no PPI exposure
Study population
PRIMARY EXPOSURE AND OUTCOMES
 Exposure measure: PPI within 14 days
 Outcome measure: C. diff toxin in 15-90 after incident CDI
 Covariates:
 Age, sex
 Comorbid conditions
 CDI- targeted antibiotic
 Non-CDI targeted antibiotic
RESULTS
RESULTS CONTD..
Model
Hazard ratio(95% CI)
P value
Unadjusted
1.42(1.11-1.82)
0.006
Adjusted
1.42(1.10-1.83)
0.008
Non-CDI antibiotic
exposure
1.71(1.11-2.64)
0.01
No antibiotic
exposure
1.30(0.94-1.79)
0.12
Study done by Kim et al.
EXPOSURE VARIABLE AND STUDY DESIGN
 Exposure variable: PPI use 3D prior to CDI
Study design
Recurrent group
Non-recurrent
group
RESULTS
UNIVARIATE ANALYSIS
 Age > 65 (60%, P=0.02)
 Fed via NGT (48.1%, P=0.04)
 Low albumin ( 2.3+/- 0.5g/dl vs. 3.1 +/- 0.4g/dl)
 PPI use (63% vs 39.8%, P=0.01)
MULTIVARIATE ANALYSIS
RISK FACTORS
ADJUSTED ODDS CI (95%)
RATIO
P VALUE
Age>65
1.32
1.12-3.87
0.03
Concurrent PPI use 1.85
1.35-4.91
0.028
Serum
albumin<2.5g/dl
3.48
1.64-7.69
0.016
NGT
1.25
0.91-2.65
0.068
Since use of PPIs is a modifiable risk factor for recurrence it is
appropriate to review, constantly, the use of PPIs in patients with
CDI.
THANK YOU
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