Drug combination linked to Clostridium outbreaks

Canadian researchers have found a connection between C. difficile cases and use of antibiotics with proton pump inhibitors.

By Victoria Stagg Elliott, AMNews staff. June 28, 2004.

Montreal hospitals battled outbreaks of Clostridium difficile that sickened hundreds and killed dozens last year, and researchers now are linking this flare-up to the use of antibiotics and proton pump inhibitors, according to a news report and a scientific study published online this month in the Canadian Medical Assn. Journal. The information will appear in the July print issue.

"The activity is higher than usual, and the patients are getting much sicker," said Sandra Dial, MD, the study's lead author and source of case statistics for the news report. She is the director of the ICU at the Montreal Chest Institute. "I sincerely hope that hospitals in America don't have to deal with what we've been dealing with because its been quite tough."

Dr. Dial's research team reviewed the medical records of more than a dozen hospitals in the area, finding more than 1,400 patients who tested positive for the bacteria in 2003. The team also linked 79 deaths to C. difficile. Researchers' analysis found that those who had received antibiotics and used PPIs were more than twice as likely to become sick.

"It's the combination of the two," said Dr. Dial. "If you only take [PPI's] and no antibiotics, your risks are very small."

American infectious disease experts are watching the situation closely. Over the past 20 years C. difficile has grown from being an occasional problem to the most common cause of infectious diarrhea in the hospital setting. Maryland's Greater Baltimore Medical Center announced eight cases in its rehabilitation unit, although that outbreak was small and did not include any fatalities.