Previous studies have examined the association between proton pump inhibitor (PPI) use and the risk of Clostridium difficile-associated disease (CDAD), with conflicting results.  Whether outpatient PPI use influences the risk of hospital admission for CDAD among older patients who have recently been treated with antibiotics is unknown.

Investigators conducted a population-based, nested case-control study of linked health care databases in Ontario, Canada, from April 1, 2002 through March 31, 2005.  They identified patients aged 66 years and older who were hospitalized for CDAD within 60 days of receiving outpatient antibiotic therapy.  Each case patient with CDAD was matched with 10 control subjects on the basis of age, sex, and details of antibiotic use (antibiotic class, timing, and number of antibiotics used).  PPI use by case patients and control subjects was categorized as current (within 90 days), recent (91–180 days), or remote (181–365 days). Conditional logistic regression was used to estimate the odds ratio for the association between outpatient PPI use and risk of hospitalization for CDAD.

Investigators identified 1,389 case patients and 12,303 matched control subjects.  Case patients were no more likely than control subjects to have received a PPI in the preceding 90 days (adjusted odds ratio, 0.9; 95% confidence interval, 0.8–1.1).  Similarly, they found no association between hospitalization for CDAD and more remote use of PPIs.

Among community-dwelling older patients, PPI use is not a risk factor for hospitalization with CDAD.