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World J Gastroenterol. Oct 28, 2013; 19(40): 6710-6713
Published online Oct 28, 2013. doi: 10.3748/wjg.v19.i40.6710
Clostridium difficile infection in the community: Are proton pump inhibitors to blame?
Daniel E Freedberg, Julian A Abrams
Daniel E Freedberg, Julian A Abrams, Division of Digestive and Liver Diseases, Columbia University Medical Center, New York, NY 10032, United States
Author contributions: Freedberg DE and Abrams JA contributed equally to this work.
Supported by National Institute of Diabetes and Digestive and Kidney Diseases T32 DK083256-0 to Freedberg DE; a National Cancer Institute Career Development Award K07 CA 132892 to Abrams JA
Correspondence to: Daniel E Freedberg, MD, Division of Digestive and Liver Diseases, Columbia University Medical Center, 630 West 168th Street, PH Bldg Floor 7, New York, NY 10032, United States. def2004@columbia.edu
Telephone: + 1-212-3420238 Fax: +1-212-3425759
Received: August 16, 2013
Revised: September 12, 2013
Accepted: September 15, 2013
Published online: October 28, 2013
Processing time: 88 Days and 9.6 Hours
Abstract

Once a nosocomial disease, Clostridium difficile infection (CDI) now appears frequently in the community in the absence of exposure to antibiotics. Prior studies have shown that patients with community-acquired CDI are younger, more likely to be female, and have fewer comorbidities compared to patients with hospital-associated CDI. Because most studies of CDI are hospital-based, comparatively little is known about community-acquired CDI. The recent study by Chitnis has received widespread attention because it used active surveillance to capture all cases of community-acquired CDI within a large population and assessed key risk factors. The authors found that low-level healthcare exposure and proton pump inhibitor use were common among those with non-antibiotics associated, community-acquired CDI. In this commentary, we discuss the changing epidemiology of community-acquired CDI and the evidence basis for the controversial association between proton pump inhibitors and community-acquired CDI.

Keywords: Clostridium difficile; Pseudomembranous enterocolitis; Proton pump inhibitors; Anti-bacterial agents; Pharmacoepidemiology; Public health; Disease outbreaks; Epidemics

Core tip: Population-based studies demonstrate that non-antibiotic associated, community-acquired Clostridium difficile infection (CDI) is increasingly common. Patients with community-acquired CDI are younger and have fewer comorbidities compared to patients with hospital-associated CDI. Proton pump inhibitors may be a risk factor for non-antibiotic associated, community-acquired CDI.