Recent reports suggest an increasing occurrence and severity of Clostridium difficile-associated disease.
Dr Sandra Dial and colleagues assessed whether the use of gastric acid-suppressive agents increases the risk of C difficile-associated disease in a community population.
The investigators conducted 2 population-based case-control studies using the United Kingdom General Practice Research Database.
In the first study, the team identified all 1672 cases of C difficile recorded between 1994 and 2004 registered for at least 2 years in each practice.
Each case was matched to 10 controls on calendar time and the general practice.
|The djusted rate ratio of C difficile-associated disease with use of PPIs was 3|
|Journal of the American Medical Association|
In the second study, a subset of these cases were defined as community-acquired, that is, not hospitalized in the prior year.
The investigators then matched these cases on practice and age with controls also not hospitalized in the prior year.
The team's main outcome measure included the incidence of C difficile and risk associated with gastric acid-suppressive agent use.
The incidence of C difficile diagnosed by general practitioners in the increased from less than 1 case per 100 000 in 1994 to 22 per 100 000 in 2004.
The investigators found that the adjusted rate ratio of C difficile-associated disease with current use of proton pump inhibitors (PPIs) was 3.
With H2-receptor antagonists the rate ratio was 2.
The team also observed an elevated rate with the use of nonsteroidal anti-inflammatory drugs, a rate ratio of about 1.
Dr Dial's team concluded, “The use of acid-suppressive therapy, particularly proton pump inhibitors, is associated with an increased risk of community-acquired C difficile.”
“The unexpected increase in risk with nonsteroidal anti-inflammatory drug use should be investigated further.”