MUHC researchers verify link between heartburn medication and community-acquired C. difficile

The findings published in the Canadian Medical Association Journal (CMAJ) today used a clinical research database to confirm that proton pump inhibitors are a risk factor for C. difficile infection. Numerous studies worldwide have documented increases in hospital C. difficile associated disease, but this study is one of only a handful to suggest this trend is mirrored in the general community.

“Our results show that drugs known to suppress stomach acid, such as heartburn medications, are associated with an increased risk of C.difficile associated disease,” says Dr. Sandra Dial, an MUHC researcher and lead author of the new study. “By reducing gastric acidity, we believe proton pump inhibitors provide a more hospitable environment within which C. difficile bacteria can colonize.”

The researchers also discovered that almost half the patients who had been diagnosed with C.difficile in the community had not received antibiotics – another known risk factor. Until recently, it had been assumed that C.difficile occurred almost entirely in patients who had taken antibiotics in a hospital setting. “These results highlight the fact that patients may develop C.difficile without receiving antibiotics in settings such as the community where antibiotic use may be less common,” noted Dr. Dial who is also 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.

The findings of this research support those of a previous study published last year by Dr. Dial and the McGill Pharmacoepidemiology Unit headed by Professor Samy Suissa. “Both these findings were new and controversial, and we felt it was important to re-examine them in a new study, using an alternate definition of C.difficile associated disease,” says Dr. Dial. “This idea was developed by doctoral candidate Chris Delaney.” The current study was performed in an out-patient setting, using a United Kingdom clinical research database. In their dataset, researchers included only those patients that had required treatment by their doctors with oral vancomycin for C.difficile.

This research was funded by the Canada Foundation for Innovation (CFI), the Canadian Institutes of Health Research (CIHR), and the Fonds de la recherché en santé du Québec (FRSQ).

Clostridium difficile, also known as C. difficile, is a bacterial microbe that can cause an infection of the bowel. The usual symptoms are diarrhea, fever and abdominal pain. Quebec-based research indicates that the most common C. difficile strain in Quebec is similar to others found in the US and Europe. The Quebec strain is resistant to a group of antibiotics called fluoroquinolones, which may have contributed to its spread through the province. Regular hand washing with soap and water is the mainstay of prevention of C. difficile infection.

The Research Institute of the McGill University Health Centre (RI MUHC) is a world-renowned biomedical and health-care hospital research centre. Located in Montreal, Quebec, the institute is the research arm of the MUHC, a university health center affiliated with the Faculty of Medicine at McGill University. The institute supports over 500 researchers, nearly 1000 graduate and post-doctoral students and operates more than 300 laboratories devoted to a broad spectrum of fundamental and clinical research. The Research Institute operates at the forefront of knowledge, innovation and technology and is inextricably linked to the clinical programs of the MUHC, ensuring that patients benefit directly from the latest research-based knowledge. For further details visit: www.muhc.ca/research.

The McGill University Health Centre (MUHC) is a comprehensive academic health institution with an international reputation for excellence in clinical programs, research and teaching. The MUHC is a merger of five teaching hospitals affiliated with the Faculty of Medicine at McGill University–the Montreal Children's, Montreal General, Royal Victoria, and Montreal Neurological Hospitals, as well as the Montreal Chest Institute. Building on the tradition of medical leadership of the founding hospitals, the goal of the MUHC is to provide patient care based on the most advanced knowledge in the health care field, and to contribute to the development of new knowledge.