Sa1229 Clinical Characteristics Associated With Initiation of Empiric Treatment for Suspected C. difficile Infection

confounders.METHODS: The study was designed as a retrospective cohort.Using electronic medical records, we identified hospitalized adult patients between September 1, 2009 and March 31, 2012 with a positive stool PCR test for C. difficile toxin B, excluding patients with a previously positive C. difficile test within 90 days of hospitalization.Electronic records were parsed for clinical factors including PPI use, other acid suppression, antibiotic use, immunosuppressant use, demographics, and comorbidities.In order to minimize loss to follow-up, patients were included only if they had clinical encounters at least 90 days beyond the initial positive test.The primary exposure was in-hospital PPI use concurrent with C. difficile treatment, defined as any dose given at least daily in frequency.Recurrence was defined as a second positive stool test 15 to 90 days after the initial positive test.C. difficile recurrence rates in the PPI exposed and unexposed groups were compared with the logrank test.Multivariable Cox proportional hazards modeling was performed to control for comorbidities and other clinical factors.RESULTS: We identified 912 patients with newly positive stool tests during the study period.The cumulative incidence of CDAD recurrence in the cohort was 18%.Receipt of PPIs concurrent with CDAD treatment was not associated with C. difficile recurrence (adjusted HR 0.84; 95% CI 0.59-1.18).Black race (adjusted HR 1.54), increased age (adjusted HR 1.02), and increased comorbidities (adjusted HR 1.10) were significantly associated with an increased risk of CDAD recurrence.Patients who received PPIs had longer hospitalizations, were more likely to stay in the ICU, were more likely to receive antibiotics or immunosuppressants, and had a higher 90-day mortality (logrank p = 0.009).In light of the higher mortality in those who received PPIs, we also analyzed the subset of patients who survived to 90 days of follow-up.Again, there was no association between PPI use and CDAD recurrence (adjusted HR 0.91; 95% CI 0.62-1.33).CONCLU-SION: Among hospitalized adults with C. difficile, receipt of PPIs concurrent with C. difficile treatment was not associated with CDAD recurrence.Black race, increased age, and increased comorbidities were predictive of recurrence.These findings suggest that PPI use in the inpatient setting does not increase the risk of CDAD recurrence.