Acid suppression therapy increases severity of C difficile disease

Patients, particularly older ones, receiving acid suppression therapy who are infected with Clostridium difficile have more severe disease and are more likely to die than patients who aren’t receiving the therapy, according to a study published in Clinical Infectious Diseases (2011;53[12]:1173-1178).

“Data published elsewhere have suggested that acid suppression therapy is a risk factor for CDI acquisition and relapse. These findings suggest an additional role in increased severity of disease, including mortality, and merit further study,” the authors conclude. Based on their results and previous research, they recommend that clinicians consider discontinuing acid suppression in patients with diagnosed or strongly suspected C difficile infection unless a contraindication, such as active peptic ulcer disease, exists.

The retrospective review of 485 cases of C difficile infection in patients between 1 and 99 years of age at the Naval Medical Center, San Diego, compared potential risk factors for complications (megacolon, surgery, intensive care unit stay, death) or death alone. Among the 47 patients who developed one or more complications and the 23 who died, the authors found independent associations between complications and acid suppression, hospitalization for C difficile infection, age 80 years or older, and corticosteroid use. Acid suppression and age 80 years or older were associated with higher odds of death.

Although more severe disease might be expected in patients with hospital-associated C difficile rather than infection diagnosed on admission, the authors found the opposite to be true. Patients admitted to the hospital with a primary diagnosis of C difficile infection had more than 4-fold higher odds of complications, though not a significantly greater risk of death.

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