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Annals of Clinical & Laboratory Science 37:241-247 (2007)
© 2007 Association of Clinical Scientists

Clostridium difficile Infection in an Urban Medical Center: Five-year Analysis of Infection Rates among Adult Admissions and Association with the Use of Proton Pump Inhibitors

Suresh Jayatilaka1,2, Rada Shakov1,2, Rodney Eddi3, Gentiana Bakaj4, Walid J. Baddoura1,2 and Vincent A. DeBari2
1 Division of Gastroenterology and 2 Department of Internal Medicine, School of Graduate Medical Education, Seton Hall University, South Orange, New Jersey; 3 Department of Internal Medicine, Mount Sinai School of Medicine, St. Joseph’s Regional Medical Center, Paterson, New Jersey; and 4 St. George’s University School of Medicine, Grenada, West Indies

Address correspondence to Vincent A. DeBari, Ph.D., St Michael’s Medical Center, 268 Martin Luther King Blvd., Newark, NJ 07102, USA; tel 973 877 2813; fax 973 754 2799; e-mail debarivi{at}shu.edu.

C. difficile-associated diarrhea (CDAD) has become a major cause of morbidity in hospitalized patients. In this study of five-year (2001–2005, inclusive) trends of incidence of CDAD among adults in an inner-city medical center, the overall annual incidence increased from 5.08 to 8.42 cases/103 admissions (p = 0.0005). Age distribution remained fairly constant for 2001–2004 but decreased significantly in 2005 (p = 0.005); no significant change was observed for gender. During the five-year period, we observed a decline in the use of histamine type 2 receptor antagonists (H2A) with a concomitant increase in the use of proton pump inhibitors (PPI) as a prophylactic measure to prevent stress ulcers. The usage of PPI correlated exactly (rs = 1.0; p = 0.017) with the increase in CDAD incidence. A case (n = 122)-control (n = 244) study for the final year was conducted, examining the association of PPI and H2A with CDAD. After controlling for the effect of antibiotic use, PPI either pre- or during admission was associated with CDAD (odds ratio, OR (adjusted) = 2.75, 95% CI = 1.68 to 4.52; p = 0.0001); the association with H2A was not significant (OR (adjusted) = 0.95, 95% CI = 0.39 to 2.34; p = 0.9153). If only first-time use during hospital stay is considered, PPI were also strongly associated with CDAD (OR (adjusted) = 1.88, 95% CI: 1.07 to 3.31; p = 0.0283) and H2A were not associated with CDAD (OR (adjusted) = 0.73, 95%CI: 0.26 to 2.06; p = 0.5520). These data suggest that the widespread prescription of PPI for stress ulcer prophylaxis in acute care facilities may contribute to the increased incidence of CDAD.

Keywords: Clostridium difficile, infectious diarrhea, stress ulcer prophylaxis, proton pump inhibitors






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