Clostridium difficile–Associated Diarrhea at a Community Hospital: Ten-Year Analysis of Infection Rates and the Relationship with Proton Pump Inhibitor Use

Abstract

Purpose To investigate the relationship between proton pump inhibitor (PPI) use and the incidence of Clostridium difficile–associated diarrhea (CDAD) at a community hospital. Methods The number of inpatient admissions, inpatient cases of CDAD, and PPI and antimicrobial doses were collected for each year from 2000 to 2009. Correlations between incidence of CDAD and doses of PPI and antimicrobials were calculated using Spearman's rank correlation coefficient analysis. Results The incidence of CDAD correlated with the number of doses of PPI per admission (ρ = 0.891, P < .001) and with the number of doses of antimicrobials per admission (ρ = 0.806, .005 > P > .001). The correlation of CDAD incidence with high-risk and low-risk antimicrobials was significant for both groups (ρ = 0.624, .05 > P > .025, and ρ = 0.881, P < .001, respectively). The correlation of oral and intravenous PPI dosing and CDAD incidence was significant for both (ρ=0.903, P < .001, and ρ=0.806, .005 > P > .001, respectively). Multiple regression analysis with both antimicrobials and PPIs as predictors of CDAD was statistically significant ( R2 = 0.75, P = .0082). Conclusion The incidence of CDAD is correlated with PPI use. Antimicrobials are a well-established risk factor for CDAD, and our study reinforces this. Prescribers should consider limiting risk of CDAD by the judicious use of PPIs.