Heart burn medication a risk factor for community-acquired C. difficile

Researchers have discovered that drugs, such as heart burn medications, which reduce gastric acidity, are potential risk factors for Clostridium difficile infection outside of hospitals. The new research to be published in the Journal of the American Medical Association (JAMA) tomorrow focuses on community-acquired C. difficile, and is a follow-up to previous work by the same group that demonstrated an increased risk from these medications in hospital settings.

“We believe drugs that reduce gastric acidity provide a more hospitable environment within which C. difficile bacteria can colonize,” says MUHC researcher and lead author of the new study Dr. Sandra Dial. Numerous studies worldwide have documented increases in hospital C. difficile associated disease, but this study is the first to suggest this trend is mirrored in the general community. Dr. Sandra Dial is Attending Staff in the Department of Critical Care at both the MUHC and Jewish General Hospital (JGH) and an Assistant Professor of Medicine at McGill University.

Using data from the United Kingdom General Practice Research Database (GPRD), researchers traced variation in community C. difficile associated disease over a 10-year period. “In 1994 there was less than one C. difficile case per 100,000 people in the database,” says Dr. Dial. “By 2004, this number had increased exponentially to 22 cases to per 100,000.” It is important to note however, that community rates are still much lower than hospitals overall.

A surprising discovery in the study was that over 70% of the patients who developed C. difficile associated disease had not been admitted to hospital in the past year, and that less than 50% had taken antibiotics in the three months prior to developing disease. “This is noteworthy because unlike previous beliefs it is now evident that C. difficile disease has left the hospital setting to reach the community and that antibiotics are not the only culprit,” says senior author of the study Dr. Samy Suissa, Director of the Division of Clinical Epidemiology at the MUHC and James McGill Professor of Epidemiology, Biostatistics and Medicine at McGill University.

This discovery follows on the heels of an announcement last week that researchers from the MUHC and JGH have sequenced the Quebec strain of C. difficile. McGill and its affiliated hospitals will continue to take a leading role in C. difficile research in order to improve treatments and prevention techniques, as well as develop more rapid diagnosis for an infection that has become a serious health concern, not just in Quebec but around the world.