Nilofar Rahman, MD

RISK OF RECURRENCE OF CLOSTRIDIUM DIFFICILE INFECTION WITH PPI USE

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

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

RESULTS CONTD..

Study done by Kim et al.

EXPOSURE VARIABLE AND STUDY DESIGN

Exposure variable: PPI use 3D prior to CDI

Study design

Recurrent groupNon-recurrent

group

RESULTS

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)

UNIVARIATE ANALYSIS

RISK FACTORS ADJUSTED ODDS RATIO

CI (95%) 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

MULTIVARIATE ANALYSIS

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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