PWE-174 Proton pump inhibitors (PPI) use and Clostridium difficile infection: guilty or innocent bystander?

Introduction PPIs have been implicated in predisposing to Clostridium difficile infection by causing hypochlorhydria. A 5–10% asymptomatic toxin burden in the community is also reported. The previously voluntary reporting of C difficile infection in UK became mandatory for all age-groups in April 2007. Aim: To compare the pattern of PPI prescribing & C difficile rates in Rotherham (industrial town in Yorkshire; pop 250k) and England (50mill.) over a 7-year period to identify any association at a community level. Methods Retrospective population study of seven consecutive years (2004/2005–2010/2011) on data of annual PPI prescriptions & C difficile incidence (both/100k pop.) in Rotherham primary care trust (PCT) and all England PCTs combined obtained from our microbiology department, Rotherham PCT, NHS Information Centre and UK Health Protection Agency. PPI prescribing trends and C difficile rates (irrespective of PPI use) in each year was compared between the two groups as % difference (Rotherham vs England: + =higher %, − =lower %). Results (Abstract PWE-174 table 1) PPI prescription: Prescription rates have risen steadily in both cohorts over the study period. Rotherham had higher rate throughout study period but gap with England in % terms has steadily narrowed. C difficile rates: Rotherham rates were much higher till 2006/2007, reversed dramatically in 2007/2008, continuing to fall for next 2 years. England rates peaked in 2007/2008 and fell steadily from 2008/2009 with hardly any gap in 2010/2011. Conclusion Strict hand hygiene in hospital and microbiologist-controlled prudent antibiotic use in hospital and community from 2002/2007 seem to have resulted in a marked fall in C difficile rates in Rotherham from 2007/2008. We presume that similar measures, gradually introduced in the rest of England during 2007, account for the more widespread but less steep fall in the England infection rates from 2008/2009.·The 7-year community level data suggests a mere association rather than true cause-effect relation between C difficile rates and PPI use in the past. Any potential risk from PPI use seems to be offset by rigorously applied hand hygiene (secondary care) and careful antibiotic prescribing (primary and secondary care) as evidenced by falling infection rates, despite rising PPI prescribing, since 2007/2008. Competing interests None declared.