Investigating the relationship between Helicobacter pylori and intestinal Clostridioides difficile infection: evidence from a cross-sectional study

Helicobacter pylori (H. pylori) infection in the stomach can lead to alterations in the gut microbiota. However, the association between H. pylori infection and Clostridioides difficile infection (CDI) remains unclear. We conducted a retrospective cross-sectional study to evaluate the association between H. pylori infection and CDI. We included patients hospitalized for diarrhea at our center between 2019 and 2024 who underwent both H. pylori and CDI testing during their hospital stay. H. pylori infection was diagnosed using either the carbon-13 urea breath test or the rapid urease test. CDI was diagnosed using a two-step testing algorithm. Patients were categorized into H. pylori-positive and -negative groups. We compared the prevalence of CDI between groups and assessed the association using logistic regression. To adjust for potential confounders, propensity score matching (PSM) was performed, followed by further analysis. We included 1,624 patients: 732 H. pylori-positive and 892 H. pylori-negative. The prevalence of CDI was significantly higher in the H. pylori-positive group (13.7%, 95% CI: 11.2%-16.2%) compared to the H. pylori-negative group (9.0%, 95% CI: 7.1%-10.8%) (P = 0.003). Univariate logistic regression showed that H. pylori infection was associated with CDI (OR: 1.606, 95% CI: 1.176–2.194; P = 0.003). Multivariate analysis also suggested that H. pylori infection was independently associated with CDI (OR: 1.817, 95% CI: 1.320–2.501; P < 0.001). This association remained significant after PSM. Our findings suggest that current H. pylori infection may be associated with Clostridioides difficile infection.