Proton-Pump Inhibitor Use and the Risk of Community-Associated Clostridium difficile Infection

Abstract

Background Proton-pump inhibitors (PPIs) have been reported to increase the risk of community-associated Clostridium difficile infection (CDI), but the association remains disputed. Methods A nationwide cohort study among adults in Denmark, 2010–2013, linking register data on C. difficile testing, filled prescriptions, and patient characteristics. All incident episodes of community-associated CDI (ie, positive culture, molecular assay, or toxin test in individuals without previous hospitalization in the prior 12 weeks and without a positive test for C. difficile in the prior 8 weeks) were identified in the Danish National Microbiological Database. Self-controlled case-series analyses were used to estimate incidence rate ratios (IRRs) for community-associated CDI, comparing periods with and without exposure to PPIs. By design, models took fixed confounders such as chronic disease, genetics, and socioeconomic status into account; further, time-varying confounders, including hospital stay and antibiotic and corticosteroid use were adjusted for. Results 3583 episodes of community-associated CDI were identified, of which 964 occurred during current use of PPIs, 324 occurred 0–6 months after treatment cessation, 123 occurred 6–12 months after treatment cessation, and 2172 occurred during time periods without use of PPIs. The adjusted IRR was 2.03 (95% confidence interval, 1.74–2.36), comparing use of PPI with nonuse. The increased risk remained elevated in later time periods: 1.54 (1.31–1.80) for 0–6 months, 1.24 (1.00–1.53) for 6–12 months after current use. Conclusions Use of PPIs was associated with moderately increased risk of community-associated CDI. The risk remained elevated up to 1 year after PPI treatment had ended.

Clostridioides difficile Infection in Children: A 5-Year Multicenter Retrospective Study

“…Our study reported a significant association between the onset of CDI and PPI use, according to the existing literature ( 13 , 14 ). How PPI administration increases the risk of CDI is unclear.…”

Factors associated to potentially inappropriate prescribing in older patients according to STOPP/START criteria: MoPIM multicentre cohort study

“…With respect to PPIs, which are widely prescribed in Spain [34], they were classified as PIMs in 167 patients. PPIs may be related to adverse outcomes, such as fractures [35], hypomagnesaemia [36][37][38][39], recurrent C. difficile infection [40,41], dementia [42,43], communityacquired pneumonia [44], or severe COVID-19 infection [45][46][47]. Remarkably, in 160 (95.8%) patients, PPI prescription was assigned to implicit STOPP criterion A1.…”

“…The Updated Charlson Comorbidity Index [22] was calculated, adjusted by age and categorized by tertiles (2-6, 7-8 and 9-14). Barthel Index was categorized as independency (100 points), minimal dependency (60-95), moderate dependency (40)(41)(42)(43)(44)(45)(46)(47)(48)(49)(50)(51)(52)(53)(54)(55), severe dependency (20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35) and complete dependency (<20) [23]. Some chronic conditions were grouped according to clinical criteria, as in Baré et.al.…”

Microbiome First Approaches to Rescue Public Health and Reduce Human Suffering

“…As can be seen in Table 1 [ 3 , 4 , 9 , 10 , 13 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 ], the danger in recent public health failures is not simply that time and money was expended in unsuccessfully combatting the NCD epidemic. It is that some of the recommendations actually further erode both the microbiome and human health.…”