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To the Editor: There is an increasing incidence of community-acquired Clostridium difficile infection (CDI) among patients regarded as low risk because they were not exposed to antimicrobial therapy.¹ In his Clinical Crossroads article discussing CDI, Dr Kelly² did not mention the potential role of the excess use of proton pump inhibitors (PPIs) in hospitals and in the community.

The inhibition of gastric acid secretion by PPIs could be an important mechanism in the increasing incidence of CDI because it is thought to suppress a fundamental physiologic defense mechanism against ingested bacteria and spores. The vegetative form of C difficile has been shown to survive in gastric contents with a raised pH,³ which could explain why patients using PPIs may be prone to colonization with C difficile. This is supported by the experimental finding that the risk of acquiring active CDI and the severity of the resulting colitis are similar . . . [Full Text of this Article]

Giuseppe Famularo, MD, PhD
gfamularo@scamilloforlanini.rm.it

Laura Gasbarrone, MD
Department of Internal Medicine
San Camillo Hospital
Rome, Italy

Claudio De Simone, MD
Department of Experimental Medicine
University of L’Aquila
L’Aquila, Italy

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