Clostridium difficile associated diarrhoea and the relationship to antibiotic prescription practices and proton pump inhibitor use in elderly wards

ABSTRACT

Clostridium difficile-associated diarrhoea [CDAD] is associated with an increased morbidity and mortality rate in elderly population. As in one of the north London hospitals, an increase in the cases of CDAD was observed in the Elderly Ward during a three-month period, the use of antibiotics and proton pump inhibitors [PPIs] was investigated for any relationship aiming to educate population and improve clinical practice during outbreaks. In the first step [Group A] undertaken from July 2005 to September 2005, administration of antibiotics was checked in patients that developed CDAD in the Geriatric Ward. In the second evaluation [Group B] after years from January 2007 to October 2007, antibiotic prescription was rechecked identically. Similarly, the assessment was conducted when PPIs were used in patients that developed CDAD. All patients were positive for C. difficile toxin in their stools. No single group of antibiotics was associated with CDAD, but in both groups, many patients who developed CDAD were on multiple drug regimes. In the second group, a proton pump inhibitor was used by one third of patients during hospitalization. Except in one case it was not discontinued when CDAD was confirmed. Restrictive policies in antibiotic consumption may help to lower the incidence of CDAD in hospitalized elderly patients