T. Kitazawa et al. / Open Journal of Gastroenterology 3 (2013) 276-280 279
(92%) [19]. Patients using PPIs tended to develop CDAD,
but the statistical significance was weak. A meta-analysis
conducted by Janarthan et al. suggested that PPIs in-
creased the incidence of CDAD [20]. This analysis was
included in the retrospective hospital-based studies and
population-based case-control studies. Clinical back-
grounds of the subjects influence the results in the study
about association between PPIs and the incidence of
CDAD.
In our study, CDAD occurred both soon after admis-
sion and later during hospitalization. Acquisition of C.
difficile and occurrence of CDAD are considered to
occur by two routes. The first route is that C. difficile
intrinsically colonizes the host intestine and proliferates
under selective pressure such as antibiotic exposure. The
second route is that C. difficile is transmitted exogen-
ously by the medical environment and proliferates after
reductions in host microflora. We believe that CDAD
mainly occurs by exogenous transmission rather than
intrinsic proliferation.
In conclusion, there were trends observed between
CDAD incidence and PPI use in patients with advanced
age, antibiotic usage and shorter hospital stays, although
statistical association between CDAD incidence and PPI
use was not demonstrated.
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