Gastric acid suppressants increase risk for recurrent C. difficile

Stopping unnecessary use of gastric acid suppressants may decrease recurrent Clostridium difficile infection, as well as health care costs, according to research published in JAMA Internal Medicine.

“Gastric acid suppression has been associated with an increased risk of primary Clostridium difficile infection (CDI), but the risk of recurrent CDI in patients taking gastric acid suppressant medications is unclear,” Raseen Tariq, MBBS, of the division of gastroenterology and hepatology at the Mayo Clinic in Rochester, Minnesota, and colleagues wrote.

Tariq and colleagues conducted a systematic review and meta-analysis to determine the association between recurrent CDI and gastric acid suppressants, including proton pump inhibitors and histamine H2 blockers. They searched several databases from Jan. 1, 1995, to Sept. 30, 2015, and identified 16 observational studies that evaluated this association in 7,703 patients with CDI in both inpatient and outpatient settings.

A total of 19.8% (n = 1,525) of patients developed recurrent CDI. Meta-analysis showed that there was an increased risk for recurrent CDI in patients who received gastric acid suppressants compared with those who did not (22.1% vs. 17.3%; OR = 1.52; 95% CI, 1.2-1.94; P < .001). This increased risk was confirmed in subgroup analyses of studies adjusting for age and potential confounders (OR = 1.38; 95% CI, 1.08-1.76; P = .02). Significant heterogeneity was observed among the studies, indicating an I² value of 64%, the researchers noted.

“In our study, we found that use of gastric acid suppression medications are associated with a statistically significant increased risk of development of recurrent [CDI] in patients with a prior episode of [CDI],” Sahil Khanna, MBBS, coauthor of the study also from Mayo Clinic, said in a press release.

While patients with gastric acid suppression may be at an increased risk for CDI recurrence, he emphasized that these data should be interpreted with caution because of factors that were not considered in the analysis, including why gastric suppression was needed.

“It may be reasonable to reevaluate the need for these medications in patients with [CDI],” Khanna concluded. – by Alaina Tedesco

Disclosure: The researchers report no relevant financial disclosures.