Diabetes, use of enteral feeding, cancer, inflammatory bowel disease, gastrointestinal surgery, and previous residence or care in an institution were not associated with the development of CDAD. Furthermore, an analysis to determine if the total number of risk factors per patient affected development of CDAD revealed no such influence (see Figure 1).

This study had several limitations. Observational case- control studies are inherently limited by random sampling error of control patients. Selection bias was minimized by defining strict matching criteria and by choosing patients from the same patient population. Although a single investigator (S.L.) collected all of the data and therefore was not blinded, the matching and statistical analyses were conducted by individuals external to the study. Furthermore, the data were limited to records at the study institution and relied heavily both on information provided by patients at the time of admission and on physician notes. It is possible that there was some discordance between the electronic patient record from which the data were gathered and the actual time of administration of the PPI. Paper charts were used when required to confirm the information in the electronic records. Also, the study did not capture information about the strain of C. difficile in each case. The most important study limitation was the strict definition of the term “current use”, which might have limited the study findings. To ensure feasibility and accuracy of data collection from the computer system, current use of PPIs was defined as use on the date of CDAD diagnosis. As such, it is possible that the number of case patients whose CDAD developed as a result of PPI use was underreported in this study. buy cialis soft tabs

Given the increase in both severity and incidence of CDAD, this study attempted to further our understanding of the risk factors involved. The risk of CDAD during the outbreak was enhanced by the use of antibiotics and the past use of PPIs, but not the current use of PPIs.

This case-control study has undoubtedly contributed to the controversial evidence surrounding this issue. As other studies have suggested, it is imperative to determine approaches to minimize both the incidence and the severity of such life- threatening infections. Further research, involving larger populations of patients with C. difficile, is needed to quantify the significance of PPI as a risk factor in the development of CDAD.