Recurrence and death after Clostridium difficile infection: gender-dependant influence of proton pump inhibitor therapy

Goals: To determine whether patients with a pre-existing PPI treatment had a higher risk of poor evolution (recurrence or death) when diagnosed with a toxicogenic Clostridium difficile digestive infection. Background: Previous studies identified pump proton inhibitor (PPI) prescription as a risk factor for C. difficile infection. The influence of PPI on the outcome of C. difficile infection is controversial. Study: This was a retrospective monocentric cohort study. All cases of patients in our center with a symptomatic infection by a toxicogenic C. difficile strain during the years 2012 and 2013 were retrospectively analyzed. The primary endpoint was the occurrence of a recurrence or C. difficile infection -related death within 2 months after diagnosis. Results: 373 patients were included in this study (198 men and 175 women), with a mean age of 70.1 +/- 18.6 years (2-100 years). Fourteen (3.7 %) patients died secondarily to C. difficile infection (median survival time 5 days), and 88 (23.6 %) experienced recurrence (after a median delay of 30 days). One hundred and ninety eight (53.1 %) patients were already receiving PPI at the time of the C. difficile infection (including 156 patients with a prescription > 1 month). When analyzing separately men and women, male patients were more likely to experience recurrence or death in case of pre-existing PPI prescription [HR = 2.32 (1.26-4.27)]; this was not observed in female patients [HR = 0.62 (0.31-1.22)]. Conclusions: Pre-existing PPI therapy may increase the risk of recurrence or death in male patients with a toxicogenic C. difficile infection. PPI risk-benefit ratio should be carefully assessed.