Acid Suppression Linked to Severe Clostridium difficile Infection
Prescription use predicted both morbidity and mortality.
In several studies, acid suppression has been associated with risk for both Clostridium difficile infection (CDI) and recurrent infection (JW Gen Med Jun 8 2010 and JW Gen Med Oct 24 2006). Other studies have suggested a link between acid suppression and severity of disease.
Researchers reviewed 485 cases of laboratory-confirmed CDI among pediatric and adult patients at a single California medical center and associated outpatient clinics between 2004 and 2008. Of 47 patients with particularly severe CDI infections, 35 experienced complications (including intensive care unit admission), and 23 died. Patients receiving prescription proton-pump inhibitors, histamine-2 blockers, or both had nearly three times the risk for complications, compared with those who did not receive acid suppression; use of corticosteroids doubled risk. Multivariate analysis showed that both acid suppression and steroid use remained significant predictors of severe infection, as did age ¥80 and hospital admission. In an analysis that was focused on mortality alone, only acid suppression and age ¥80 were independent risk factors.
Comment: The biological plausibility of a link between acid suppression and CDI incidence and severity is strong, and the accumulating research is difficult to dismiss. Presumably, this study’s findings could have been attenuated by widespread use of over-the-counter acid suppressants, but the results are enough in tune with other research that clinicians might reasonably discontinue acid suppressants in all proven or possible CDI patients who have no clear indications for continuing therapy.
Abigail Zuger, MD
Published in Journal Watch General Medicine January 17, 2012