Brief Article
Copyright ©2010 Baishideng. All rights reserved.
World J Gastroenterol. Jul 28, 2010; 16(28): 3573-3577
Published online Jul 28, 2010. doi: 10.3748/wjg.v16.i28.3573
Proton pump inhibitors as a risk factor for recurrence of Clostridium-difficile-associated diarrhea
Ji Won Kim, Kook Lae Lee, Ji Bong Jeong, Byeong Gwan Kim, Sue Shin, Joo Sung Kim, Hyun Chae Jung, In Sung Song
Ji Won Kim, Kook Lae Lee, Ji Bong Jeong, Byeong Gwan Kim, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Seoul National University Boramae Hospital, Seoul National University College of Medicine, Seoul 156-707, South Korea
Sue Shin, Department of Laboratory Medicine, Seoul National University Boramae Hospital, Seoul National University College of Medicine, Seoul 156-707, South Korea
Joo Sung Kim, Hyun Chae Jung, In Sung Song, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 110-744, South Korea
Author contributions: Kim JW and Lee KL designed the study and wrote the manuscript; Jeong JB, Kim BG and Shin S coordinated and provided the patients’ data; Kim JS, Jung HC and Song IS analyzed the data and were involved in editing the manuscript.
Supported by A Seoul National University Boramae Hospital Grant (03-2007-1)
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
Received: February 25, 2010
Revised: April 13, 2010
Accepted: April 20, 2010
Published online: July 28, 2010
Abstract

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.

Keywords: Clostridium difficile, Diarrhea, Recurrence, Risk factors, Proton pump inhibitors