By David Wild

Originally published by our sister publication, Gastroenterology & Endoscopy News

Non-aspirin nonsteroidal anti-inflammatory drugs (NSAIDs) do not increase the risk for Clostridioides difficile infection (CDI), according to a retrospective review of nearly 1,500 people. The results stand in contrast to prior findings that have suggested an association between NSAID use and CDI.

“To our knowledge, this is the first study of NSAID use as a risk factor for CDI to account for treatment assignment bias utilizing propensity score matching,” noted lead investigator Adam Ressler, MD, from the Department of Internal Medicine, Division of Infectious Disease, at the University of Michigan, in Ann Arbor, and his co-investigators (Anaerobe 2021 Sep 8. https://doi.org/10.1016/j.anaerobe.2021.102444). “This is significant, as it increases our confidence that our modeled risk of CDI is causally related to NSAID use itself, rather than the underlying indication for the NSAID use.”

The authors said prior research on the topic that found an association between NSAID use and CDI “had two major limitations, [including] inadequate assessment of over-the-counter NSAID use and failure to account for treatment assignment bias.”

In this study, Dr. Ressler and his team identified 628 CDI cases from a previously published cohort treated at Michigan Medicine and 628 controls who had diarrhea suspicious for CDI but who tested negative for CDI. They analyzed data for prescribed and over-the-counter non-aspirin NSAID use within 30 days of CDI, as well comorbidities and baseline laboratory findings.

To overcome the weaknesses of prior research, patients with CDI and NSAID use were closely matched with non-CDI NSAID users according to sex, presence of back pain and arthritis, baseline serum creatinine, serum albumin, and use of anticoagulants of antiplatelet medications.

The investigators found that 22% to 26% of those with or without CDI had used non-aspirin NSAIDs during the previous month, with analyses confirming there was no elevated CDI risk among those receiving NSAIDs (odds ratio [OR], 0.97; 95% CI, 0.72-1.29; P=0.816).

The only significant risk factors for CDI they found were older age (OR, 1.09; CI, 1.01-1.17; P=0.02), scores on the weighted Elixhauser Comorbidity Index, a measure of comorbidity burden (OR, 0.98; 95% CI, 0.97-0.99) and prior CDI (OR, 2.64; 95% CI, 1.96-3.56).

Dr. Ressler and his colleagues concluded that their “findings do not support an association between NSAID use and an increased risk for CDI.”