Influence of Development of Proton Pump Inhibitors andPotassium-competitive Acid Blockers on Clostridioides Difficile Infection

Abstract

Clostridioides difficile infection (CDI) is the major cause of nosocomial infectious diarrhea. Previous studies reported that the use of gastric acid suppressors increases the risk of CDI. In the present study, we compared the risk of CDI due to the use of proton pump inhibitors (PPI) and potassium-competitive acid blockers (P-CAB). Inclusion criteria were patients who were hospitalized, at least 65 years old, and received antimicrobial treatment.

The use of PPI or P-CAB increases the risk of CDI (P < 0.05, odds ratio (OR): 1.92, 95％ confidence interval (95％CI): 1.071 - 3.456). We also extracted 560 cases each from the PPI and P-CAB groups using propensity score matching. There was no significant difference in the onset of CDI between the two groups (P = 0.194, OR: 2.02, 95％CI: 0.685 - 5.943).

Our findings suggest that the increase in the risk of CDI by gastric acid suppressors is caused by the maintenance of intragastric pH ≥ 5 although the effect of the gastric acid suppression strength is expected to be small.