1370. Does Alkaline Colonic pH Predispose to Clostridium difficile Infection?
Session: Poster Abstract Session: Clostridium difficile
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C

Background: There has been a rise in the incidence and severity of Clostridium difficile Infection (CDI) in the past decade. Proton pump inhibitors (PPIs) have been recently identified as a predisposing factor by increasing the survival of the vegetative forms of C. difficile in response to decreased acid levels. The association between colonic pH and CDI has not been studied. Our aim was to determine if alkaline colonic pH (measured by stool pH) predisposes to colonization and infection with C. difficile.

Methods: Hospitalized patients ≥ 18 years of age with 3 or more loose bowel movements / day, and/or abdominal pain, leukocytosis and fever were included. Stool pH was measured by a portable digital pH meter (Jenco 5005). C. difficile in stool was detected by “C. Diff Quik Chek Complete” test kit (Alere Inc.), which uses a combination of glutamate dehydrogenase (GDH) antigen and toxins (Tox) A and B assays. Patients were divided into 3 groups- positive for CDI (GDH+/Tox+), negative for CDI (GDH-/Tox-) and colonized with C. difficile (GDH+/Tox-). Stool pH was compared across the groups.

Results: A total of 228 patients were included. Out of the 171 patients that tested negative, 93 (54.4%) had stool pH > 7.0 and 78 (45.6%) had ≤ 7.0.  In contrast, among the 30 patients who tested positive, stool pH was > 7.0 in 26 (86.7%) and ≤ 7.0 in 4 (13.3%) (p = 0.002 vs. GDH-/Tox-). Among the 27 patients who were colonized, 12 (44.4%) had stool pH > 7.0 and 15 (55.6%) had ≤ 7.0 (p = 0.34 vs. GDH-/Tox-). Among all patients with stool pH ≤ 7.0, 96% tested negative for CDI. There was no significant difference among the groups in terms of demographic characteristics, underlying medical conditions, and use of PPIs or enteral feeds. Patients with CDI more often had a history of gastro-intestinal surgery compared with those without CDI (p=0.02).

Conclusion: C. difficile colitis is associated with alkaline stool pH.  Although the relationship is likely to be causative, our data does not exclude the possibility that CDI results in an increased stool pH.  

Purba Gupta, MD1,2, Stanley Yakubov, MD1, Kevin Tin, MD1, Olga Garankina, MD1,2, Manali Pednekar, MD1,2, Diego Zea, MD1,2, Farah Chinwalla, DO1,2, Khawar Khurshid, MD1,2, Maxine Seales, MD1, Yu Shia Lin, MD1,2, Monica Ghitan, MD1,2, Edward Chapnick, MD1,2 and Michael Koegel, MD1, (1)Department of Internal Medicine, Maimonides Medical Center, Brooklyn, NY, (2)Division of Infectious Diseases, Maimonides Medical Center, Brooklyn, NY


P. Gupta, None

S. Yakubov, None

K. Tin, None

O. Garankina, None

M. Pednekar, None

D. Zea, None

F. Chinwalla, None

K. Khurshid, None

M. Seales, None

Y. S. Lin, None

M. Ghitan, None

E. Chapnick, None

M. Koegel, None

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