Administration of proton pump inhibitors in critically ill medical patients is associated with increased risk of developing Clostridium difficile–associated diarrhea

Buendgens, Lukas; Bruensing, Jan; Matthes, Michael T.; Dückers, Hanna; Luedde, Tom; Trautwein, Christian; Tacke, Frank; Koch, Alexander

doi:10.1016/j.jcrc.2014.03.002

Cited by 96 publications

(58 citation statements)

References 24 publications

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“…Recent studies have even suggested an association between the use of proton pump inhibitors and occurrence of CDI. 16,17 We found several risk factors among our cohort; some of which are consistent with those found in the general patient population, including older age, higher illness severity, preoperative inpatient stay, and emergent admission status, the strongest being preoperative inpatient stay. The strong association between longer preoperative LOS and CDI occurrence is expected, as increased time in the inpatient setting increases a patient's exposure risk profile.…”

Section: Factors Associated With the Development Of CDIsupporting

confidence: 83%

Clostridium difficile Infection After Colorectal Surgery: A Rare but Costly Complication

Damle

Cherng

Flahive

et al. 2014

Journal of Gastrointestinal Surgery

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Section: Factors Associated With the Development Of CDIsupporting

confidence: 83%

Clostridium difficile Infection After Colorectal Surgery: A Rare but Costly Complication

Damle

Cherng

Flahive

et al. 2014

Journal of Gastrointestinal Surgery

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“…82 An association between PPIs and CDI has been found among outpatients, 83 inpatients, 84 and patients in intensive care units. 85 Multiple meta-analyses and population-based data support these findings. 80,81 A program of active surveillance undertaken by the Centers for Disease Control that covers over 11 million people found that PPI exposure was 5% higher among those with CDI who did not report exposure to antibiotics, compared to those with CDI who did report exposure to antibiotics.…”

Section: Effects Of Proton Pump Inhibitors On the Microbiomementioning

confidence: 90%

The Impact of Proton Pump Inhibitors on the Human Gastrointestinal Microbiome

Freedberg

Lebwohl

Abrams

2014

Clinics in Laboratory Medicine

145

118

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Potent gastric acid suppression using proton pump inhibitors (PPIs) is common in clinical practice yet may have important effects on human health that are mediated through changes in the gastrointestinal microbiome. Acting through pH-dependent or pH-independent mechanisms, PPIs have the potential to alter the normal microbiota throughout the human gastrointestinal lumen. In the esophagus, PPIs change the normal bacterial milieu to decrease distal esophageal exposure to inflammatory Gram-negative bacteria which may lower the risk of Barrett's esophagus. In the stomach, PPIs alter the abundance and location of gastric Helicobacter pylori and other bacteria, which has implications for peptic ulcer disease and gastric malignancy. In the small bowel, PPIs cause polymicrobial small bowel bacterial overgrowth and have been associated with the diagnosis of celiac disease. In the colon, PPIs associate with incident but not recurrent Clostridium difficile infection, putatively through alterations in commensal colonic anaerobes. Our understanding of the effect of gastric acid suppression on the human gastrointestinal microbiome is incomplete but is rapidly advancing.

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“…High acidity, in combination with pepsin and lipase, kills ingested microorganisms and limits bacterial overgrowth, enteric infection (e.g., Clostridium difficile), and possibly spontaneous bacterial peritonitis [5][6][7][8].…”

Section: Introductionmentioning

confidence: 99%