Treatment of H. pylori not linked with future C. difficile infection
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Neither treatment of nor complete eradication of Helicobacter pylori infection was associated with future Clostridioides difficile infection in a large study of United States veterans, according to research published in The American Journal of Gastroenterology.
Shria Kumar, MD, of the division of gastroenterology and hepatology at the Perelman School of Medicine at the University of Pennsylvania, and colleagues wrote that the increasing awareness of possible resistance and side effects of antibiotic treatment has led some to warn against H. pylori eradication.
“They argue that eradication of H. pylori can be associated with antibiotic resistance, antibiotic associated diseases, and changes in the microbiome that could have downstream consequences,” Kumar and colleagues wrote. “A particularly concerning, yet uninvestigated, area is the association of H. pylori treatment with [Clostridioides] difficile infection.”
Researchers analyzed data from 38,535 patients within the Veterans Health Administration who had detected H. pylori from 1994 to 2018. The primary outcome was a positive laboratory test for CDI within 3 months of H. pylori detection. They also sought to determine if H. pylori eradication was associated with CDI.
In the patient cohort, 28,818 individuals underwent treatment for H. pylori (74.8%), and 284 developed CDI (0.74%). Investigators found that hospital discharge within 12 weeks (OR = 2.15; 95% CI, 1.22–3.77) and within 4 weeks (OR = 3.46; 95% CI, 2.18–5.48), as well as previous CDI (OR = 12.5; 95% CI, 9.21–17), were prominent factors associated with CDI.
However, neither treatment of H. pylori nor confirmation of eradication were associated with future CDI (OR = 1.49; 95% CI, 0.67–3.29).
Kumar and colleagues wrote that their findings show that H. pylori treatment does not increase risk for CDI and reaffirms what is currently known about risk factors for the infection.
“History of CDI and recent hospitalization are the most important factors for future CDI,” they wrote. “Although this should be confirmed in prospective studies, our findings suggest that H. pylori should be continued to be treated when detected, given that it likely modifies future gastrointestinal disease risks, including peptic ulcer disease, gastric lymphoma, and adenocarcinoma.”
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