C diff

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In 2012, the U.S. Food and Drug Administration (FDA) announced that the use of proton pump inhibitors (PPIs) may be associated with an increased risk of Clostridium difficile–associated diarrhea (CDAD). C. difficile, more commonly known as C. diff, is a bacterium that causes inflammation of the colon, or colitis. It is a gram positive anaerobic spore forming bacteria that is most commonly seen in cases of hospital associated diarrhea. Symptoms of the infection include persistent diarrhea, watery stool, fever, abdominal pain, and the more serious development of toxic megacolon.
The incidence and severity of the C. diff infection are increasing. Risk factors that may contribute to a person developing the infection include age, antibiotic use, immunosuppression, lengthy hospital visits, and certain chronic medical conditions. Recently, proton pump inhibitors have received much attention in its association with C. diff. In a 2013 article in JAMA Internal Medicine, community-associated C. diff infections without antibiotic exposure had a trend towards having received Proton Pump Inhibitors more frequently than patients with antibiotic exposure. The basis for this trend is due to the PPIs ability to decrease the acidity of the stomach.
PPIs work by inhibiting the H+/K+-ATPase enzyme which suppresses gastric acid secretion in the stomach parietal cell. The stomach becomes more basic and the pH increases. Bacteria have a better chance of surviving in an environment of a higher pH. PPIs inhibit the body’s natural defense against many organisms. They interrupt the high acidity of the stomach, lowering our defense mechanism, and allowing colonization and multiplication of bacteria associated with C.diff. The American Journal of Gastroenter...

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...nd with spores. Since this is a spore forming bacteria, hand sanitizers and alcohol will not kill the bacteria. It is of most importance for hospital staff and those in contact with the infected individual, including family, to practice proper hand hygiene by washing hands with soap and water.
When deciding whether or not to use a PPI, it is important to look at the risks and the benefits. PPIs used as a maintenance medication, for chronic disease states, may not be the most appropriate choice. However, sometimes using PPIs is unavoidable. When appropriate, de-escalation of PPIs may be beneficial by reducing the incidence of C. diff. Tapering doses, switching to H2RAs, or using antacids when needed are alternatives to chronic PPI use. Healthcare professionals need to vigilant in monitoring their patient’s progression to determine the appropriate course of therapy.

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