Introduction:
Clostridium difficile infection (CDI) is one of the most common gastrointestinal illnesses. However, there are conflicting studies regarding the association of CDI with Helicobacter Pylori (H pylori) treatment regimens. Our aim is to investigate the risk of CDI in those treated for H. pylori as well as characterize other risk factors for developing CDI.
Methods:
A retrospective study was performed in the adult population diagnosed with H. pylori within the Beaumont Hospital system in Michigan, from 2010 to 2021. Inclusion criteria included age > 18 years and diagnosis of H. pylori with one of three proven methods: endoscopic biopsy with pathology, stool antigen test or urea breath test. Treatment was defined as being prescribed any one of the established multi-regimen therapies used to treat H. pylori. Diagnosis of CDI was queried in two groups: within 6 months and 12 months of H pylori diagnosis, while both required a positive stool toxin or PCR for diagnosis. Analysis was performed using SAS 9.4 (SAS Institute, Cary, NC). (Table, Figure)
Results:
Among 11,457 patients, 56 (0.48%) had a subsequent CDI, with 5 (0.21%) and 35 (0.38%) among treated and untreated groups respectively. A total of 2341 (20.43%) patients were treated for H. pylori infection, and the most common regimen was clarithromycin based triple therapy in 1944 (17%). In a case control analysis for CDI within 6 months of H. pylori diagnosis, matched for 10-year age interval, sex and 3-unit BMI intervals with those without CDI, 23 (41.1%) vs 17 (30.4%) had been prescribed an antibiotic known to be associated with CDI, 5 (8.9%) vs 4 (7.1%) had been prescribed a histamine receptor 2 (H2) blocker, and 30 (53.6%) vs 29 (51.8%) had been prescribed a proton pump inhibitor (PPI). The odds of previous hospitalization among those who developed CDI are 300% greater than those who did not develop CDI (p value 0.04).
Conclusion:
We found that there was no association of future CDI with treatment of H. pylori infection. This result was similar to the study done by Kumar et. al. in a large veteran population, which did consist of a higher percentage of male patients, and our study consists of more female patients. In addition, our study reaffirms the notion that previous hospitalization is a risk factor for developing CDI. There were a few limitations including the inability to confirm if patients received treatment from an external electronic medical record or if they completed the prescribed treatment regimens.Figure 1.: CDI in H. pylori diagnosed patients
Table 1. -
Comparison of characteristics of H. pylori diagnosed populations within 12 months of CDI and without CDI
Total CDI (56)
No CDI (1401)
Mean Age, in years
57.6
47.8
Sex
Female
38 (67.9%)
6823 (59.8%)
Male
18 (32.1%)
4578 (40.2%)
Race
Caucasian
28 (50%)
5934 (52%)
African American
16 (28.6%)
1788 (15.7%)
Others
10 (17.9%)
2786 (24.4%)
Treatment Regimen within 180 days
Clarithromycin based triple therapy
5 (8.9%)
1939 (17.0%)
Clarithromycin based concomitant therapy
3 (5.4%)
211 (1.9%)
Bismuth quadruple therapy
0
246 (2.2%)
Levofloxacin based triple therapy
0
130 (1.1%)
Levofloxacin based quadruple therapy
0
2
Rifabutin based therapy
0
13 (0.1%)
