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

Cited 79 time in Web of Science Cited 83 time in Scopus
Authors
Kim, Ji Won; Lee, Kook Lae; Jeong, Ji Bong; Kim, Byeong Gwan; Kim, Joo Sung; Song, In Sung; Jung, Hyun Chae; Shin, Sue
Issue Date
2010-07-28
Publisher
W J G PRESS
Citation
WORLD JOURNAL OF GASTROENTEROLOGY; Vol.16 28; 3573-3577
Keywords
Clostridium difficileDiarrheaRecurrenceProton pump inhibitorsRisk factors
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.
ISSN
1007-9327
Language
English
URI
https://hdl.handle.net/10371/76284
DOI
https://doi.org/10.3748/wjg.v16.i28.3573
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College of Medicine/School of Medicine (의과대학/대학원)Laboratory Medicine (검사의학전공)Journal Papers (저널논문_검사의학전공)
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