Risk factors for recurrence of clostridium difficile-associated diarrhoea.

Background/aims: Clostridium difficile associated disease (CDAD) is one of the most common causes of hospital-acquired diarrhea. Despite increasing incidence of clostridium difficile-associated diarrhea, there are few data on risk factors associated with its relapse.

Methodology: We studied retrospectively possible risk factors for the recurrence of CDAD; 124 patients fulfilled the criteria of CDAD during the study period between January 2006 and July 2009. After successful treatment, recurrence occurred in 20 patients.

Results: Nineteen patients (95%, p = 0.029) in the relapse group were on long term proton pump inhibitor therapy compared to 77 patients (74%) in the non-relapse group. There was no statistically significant difference in severity (CRP: p = 0.442, leucocytosis: p = 0.415) and length of hospitalization (p= 0.539) in both studied groups; however, CDAD-relapse was associated with more hospital readmissions and increased health care costs.

Conclusions: Proton pump inhibitor therapy may be associated with increased risk of recurrence of CDAD, and represents a relevant, yet correctable risk factor. In patients at risk for CDAD, proton pump inhibitors should be used carefully.