Older age , use of antibiotics after diagnosis , use of proton pump inhibitors , and strain type were the most frequent risk factors for recurrence .
Older age , leucocytosis , renal failure and co-morbidities were frequent risk factors for complicated CDI .
When considered alone , mortality was associated with age , co-morbidities , hypo-albuminemia , leucocytosis , acute renal failure , and infection with ribotype 027 .
BACKGROUND Clostridium difficile infection ( CDI ) can lead to complications , recurrence , and death .
Numerous studies have assessed risk factors for these unfavourable outcomes , but systematic review s or meta-analyses published so far were limited in scope or in quality .
Proton Pump Inhibitor Use and Recurrent Clostridium difficile-associated Disease: A Case-control Analysis Matched by Propensity Score
Background and Aim : Clostridium difficile has been increasingly diagnosed in hospitalized patients . An association between proton pump inhibitors ( PPIs ) use and Clostridium difficile-associated disease ( CDAD ) and between recurrent CDAD has been suggested . The aim of this study is to investigate whether PPI use is associated with the development of recurrent CDAD . Methods : This was a retrospective case-control study of patients with CDAD at Yeungnam University Medical Center , seen from January 2004 to December 2008 . C. difficile infection was diagnosed by the presence of C. difficile toxin in the stool . Those with recurrent disease were matched with nonrecurrent controls using multivariate matched sampling methods that incorporated the propensity score . Results : Recurrent CDAD developed in 28 ( 14.1 % ) of the 198 patients with diarrhea and positive C. difficile stool toxin assays . Multivariate analysis of the total population of recurrent versus nonrecurrent CDAD revealed that additional use of non-C. difficile antimicrobial therapy  ( concomitant with the treatment or after or both ) , poor response to therapy with metronidazole  or vancomycin , and recent gastrointestinal surgery were risk factors for recurrent CDAD . We were able to match 21 recurrent CDAD subjects with 21 without recurrent CDAD . Among the matched patients only PPI use was associated with recurrent CDAD ( ie , 47.6 % vs. 4.8 % , P=0.004 for recurrent vs. nonrecurrent CDAD , respectively ) . Conclusions : Among the matched patient groups , only PPI therapy was associated with recurrent CDAD . Prospect i ve studies are needed to clarify whether avoidance of PPIs or specific cotherapies will reduce the incidence of recurrent C. difficile-associated diarrhea
Older age , use of antibiotics after diagnosis , use of proton pump inhibitors , and strain type were the most frequent risk factors for recurrence .
Older age , leucocytosis , renal failure and co-morbidities were frequent risk factors for complicated CDI .
When considered alone , mortality was associated with age , co-morbidities , hypo-albuminemia , leucocytosis , acute renal failure , and infection with ribotype 027 .
BACKGROUND Clostridium difficile infection ( CDI ) can lead to complications , recurrence , and death .
Numerous studies have assessed risk factors for these unfavourable outcomes , but systematic review s or meta-analyses published so far were limited in scope or in quality .