Clostridioides difficile Infection in Patients Undergoing Acid-Suppressive Treatment: A Large Cohort Study with Propensity Score Matching

Introduction: Clostridioides difficile infection (CDI) is a significant concern in patients undergoing acid-suppressive therapy. This study aimed to evaluate and compare the risk of CDI in patients treated with proton pump inhibitors (PPIs), histamine 2 receptor antagonists (H2RAs), and potassium-competitive acid blockers (tegoprazan).

ing. The primary outcome was CDI incidence within 12 weeks of medication use. Results: Patients receiving PPIs exhibited a significantly higher relative risk (RR) (RR: 1.86; 95% confidence interval [CI]: 1.18–2.91) of developing CDI than those receiving H2RAs. Tegoprazan showed no significant increase in CDI risk (RR: 1.07; 95% CI: 0.64–1.79) compared to H2RAs. The risk of CDI increased with a longer duration of acid suppressant use. No dose-dependent differences in CDI occurrence were observed across PPI doses and no significant differences were found in the incidence of severe CDI among the groups. Conclusions: PPIs are associated with a higher risk of CDI than H2RAs. These findings highlight the need for careful selection of acid-suppressive therapies, particularly in high-risk populations.