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PTH-027 Stopping Proton Pump Inhibitors to Prevent Clostridium Difficile: Is it Possible and Does it Help?
  1. M Popescu1,
  2. K Welch1,
  3. R Cunninghan2,
  4. S Lewis1
  1. 1Gastroenterology
  2. 2Microbiology, Derriford Hospital, Plymouth, UK

Abstract

Introduction Hypochlorhydydria due to proton pump inhibitor (PPI) therapy is associated with increased susceptibility and propensity to relapse from infection due to C difficile. The Health Protection Agency guidance advises review of PPI use in patients with CDAD. We have done a retrospective audit of patients with CDAD examining PPI use and any benefit achieved by stopping the PPI.

Methods All patients with CDAD between 2010–12 were reviewed by infection control nurses and advised the attending doctors to stop any PPI therapy where a clear indication was not obvious. We have retrospectively audited patient’s relevant baseline characteristics, clinical outcome, length of hospital stay and PPI prescription at hospital discharge. In addition we followed patients up for 90days post discharge recording PPI prescription and further CDAD.

Results 75 patients, 38 taking a PPI (mean age 77 stD) and 37 not taking a PPI (mean age 72 StD). No difference was seen for antibiotic use, co morbidity, immunosuppression, recent surgery, enteral feeding or dependency. At hospital discharge of those taking a PPI 12/38 (32%) had died. The PPI was stopped in 17/26 (65%), further CDAD occurred in 3 taking a PPI and 5 not. Of those not taking a PPI on hospital admission 16/37 (43%) died by hospital discharge and at 90days 4 developed further CDAD.

Conclusion It was possible to stop PPI prescription in 65% of patients presenting with CDAD. We found no evidence that CDAD was more severe in patients taking a PPI or that there was reduced recurrence of CDAD in patients who had stopped taking their PPI or had never taken it.

Disclosure of Interest None Declared.

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