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Updated: Sep 13, 2025

Cefoperazone-treated Mouse Model of Clinically-relevant Clostridium difficile Strain R20291
Published on: December 10, 2016
Clostridioides difficile Infection in Patients Undergoing Acid-Suppressive Treatment: A Large Cohort Study with
Ilsoo Kim1, Joon Sung Kim2, Jae Myung Park3
1Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea, ilsookim86@gmail.com.
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).
Methods:
This retrospective observational cohort study evaluated 606,460 individuals who were prescribed PPIs, H2RAs, or tegoprazan for more than 7 days, resulting in 22,431 matched individuals after propensity score matching. 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.
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