Open AccessThe Association between GABA-Modulators and Clostridium difficile Infection – A Matched Retrospective Case-Control Study
Author(s) -
Jonathan Ström,
Johan Tham,
Fredrik Månsson,
Jonas Ahl,
Tor Savidge,
Sara M. Dann,
Fredrik Resman
Publication year - 2017
Publication title -
plos one
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.99
H-Index - 332
ISSN - 1932-6203
DOI - 10.1371/journal.pone.0169386
Subject(s) - zopiclone , zolpidem , medicine , retrospective cohort study , case control study , pregabalin , propensity score matching , clostridium difficile , clindamycin , gabapentin , odds ratio , antibiotics , pharmacology , hypnotic , anesthesia , biology , microbiology and biotechnology , pathology , alternative medicine , insomnia
Objective Recently, metabolomics studies have suggested that the neurotransmitter γ-amino butyric acid (GABA) may modulate C . difficile infection (CDI) pathogenesis. In the present study, we investigated the association between GABA-modulating pharmaceuticals and CDI development. Methods In July-December 2013, we performed a matched, retrospective case-control study in Skåne county, Sweden, to assess the association between the use of GABA-modulators (defined as regular use of at least one of the following: zolpidem, zopiclone, benzodiazepines, gabapentin, pregabalin or baclofen) and CDI. Multivariate regression models, adjusted for known risk factors for CDI, were fitted to assess the associations and a propensity score-adjusted analysis was performed. Results The study included 292 cases and 292 matched controls. In a multivariate regression model only recent antibiotic use (clindamycin, cephalosporins and fluoroquinolones) and nursing home residency was significantly associated with CDI. The regular use of any GABA-modulator was not associated with CDI (OR = 1.07, 95%CI 0.69–1.66, p = 0.76). The association between regular use of the selective GABA-agonist zolpidem and CDI trended towards significance (OR = 2.31, 95%CI 0.91–5.86, p = 0.078). These associations remained when only cases treated with antibiotics were included. Corresponding findings for zolpidem was observed in a propensity-score adjusted analysis (OR = 2.52, 95% CI 0.91–6.97, p = 0.075). Severe initial CDI was significantly associated with CDI recurrence (OR = 3.77, 95% CU 1.20–11.86, p = 0.023). Conclusion This study did not identify a general association between GABA-modulators and CDI. A trend towards a significant association between zolpidem and CDI was observed, an association that should be re-assessed in a study appropriately powered for this particular hypothesis.