Proton pump inhibitors and diarrhoea related to Clostridium difficile infection in hospitalised patients: a case–control study

The incidence and disease severity of Clostridium difficile infection are rising. There is increasing evidence of a potential association between proton-pump inhibitors (PPI) and C. difficile infection. We performed a case-control study to examine the relationship between PPI and polymerase chain reaction (PCR)-proven C. difficile infection in 137 hospitalised patients in a tertiary hospital in Western Australia. Only antibiotic exposure within 3 months prior to onset of diarrhoea was associated with PCR-proven C. difficile infection (odds ratio 5.97, 95% confidence interval 2.40-14.8, P= 0.001). A restricted analysis on those who had exposure to antibiotics within 3 months before the onset of diarrhoea did not change the negative association between PPI exposure and PCR-proven C. difficile infection. Long-term PPI usage and intensity of PPI exposure prior to onset of diarrhoea were not significantly associated with C. difficile infection.