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. 2016 Apr 11:5:430.
doi: 10.1186/s40064-016-2058-z. eCollection 2016.

Recurrence and death after Clostridium difficile infection: gender-dependant influence of proton pump inhibitor therapy

Ophélie Dos Santos-Schaller  1 , Sandrine Boisset  2 , Arnaud Seigneurin  3 , Olivier Epaulard  4
Affiliations

Recurrence and death after Clostridium difficile infection: gender-dependant influence of proton pump inhibitor therapy

Ophélie Dos Santos-Schaller et al. Springerplus. .

Abstract

Goals: To determine whether patients with a pre-existing PPI treatment had a higher risk of poor evolution (recurrence or death) when diagnosed with a toxicogenic Clostridium difficile digestive infection.

Background: Previous studies identified pump proton inhibitor (PPI) prescription as a risk factor for C. difficile infection. The influence of PPI on the outcome of C. difficile infection is controversial.

Study: This was a retrospective monocentric cohort study. All cases of patients in our center with a symptomatic infection by a toxicogenic C. difficile strain during the years 2012 and 2013 were retrospectively analyzed. The primary endpoint was the occurrence of a recurrence or C. difficile infection -related death within 2 months after diagnosis.

Results: 373 patients were included in this study (198 men and 175 women), with a mean age of 70.1 ± 18.6 years (2-100 years). Fourteen (3.7 %) patients died secondarily to C. difficile infection (median survival time 5 days), and 88 (23.6 %) experienced recurrence (after a median delay of 30 days). One hundred and ninety eight (53.1 %) patients were already receiving PPI at the time of the C. difficile infection (including 156 patients with a prescription >1 month). When analyzing separately men and women, male patients were more likely to experience recurrence or death in case of pre-existing PPI prescription [HR = 2.32 (1.26-4.27)]; this was not observed in female patients [HR = 0.62 (0.31-1.22)].

Conclusions: Pre-existing PPI therapy may increase the risk of recurrence or death in male patients with a toxicogenic C. difficile infection. PPI risk-benefit ratio should be carefully assessed.

Keywords: Clostridium difficile; Death; Gender; Proton pump inhibitor; Recurrence.

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Figures

Fig. 1
Fig. 1
Kaplan–Meier curves of the composite risk of C. difficile infection (CDI) recurrence and CDI-related death in males (a) and females (b), in patients with proton pump inhibitor prescription during more than 1 month before CDI diagnosis (bold line) and other patients (thin line)
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