Association of Gastric Acid Suppression With Recurrent <i>Clostridium difficile</i> Infection

Tariq, Raseen; Singh, Siddharth; Gupta, Arjun; Pardi, Darrell S.; Khanna, Sahil

doi:10.1001/jamainternmed.2017.0212

Cited by 136 publications

(96 citation statements)

References 48 publications

(94 reference statements)

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“…Targets for the reduction in CDI have been established by the Centers for Medicare and Medicaid Services and are being adopted by hospitals across the country as part of the Hospital Inpatient Quality Reporting Program . However, important questions remain unanswered regarding prevention, treatment, and recurrence of CDI in transplant patients …”

Section: Discussionmentioning

confidence: 99%

Clostridioides difficile infection and recurrence among 2622 solid organ transplant recipients

Schluger

Rosenblatt

Knotts

et al. 2019

Transplant Infectious Dis

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Background Clostridioides difficile infection (CDI) is common after solid organ transplant (SOT) and is associated with high morbidity and mortality. Methods We assessed incidence, risk factors, and outcomes of CDI among SOT patients at a large multi‐organ transplant center. Multivariable logistic regression was used to identify risk factors for initial and recurrent CDI. Results A total of 2622 SOT patients were included. 224 (8.5%) had CDI 1 year post‐SOT. The highest incidence of CDI was among pancreas recipients (12.5%) followed by lung (11.7%), liver (11.0%), heart (10.8%), and kidney (5.8%). Median time to CDI was 56 days (range 2‐354) post‐SOT. About 64% of patients had severe CDI. About 56.3% were treated with metronidazole, 13.8% with oral vancomycin, and 28.6% with both. About 28.6% of patients had recurrent CDI. In multivariable modeling, lung transplant recipient status was the only significant predictor of recurrent CDI (OR 4.97, 95% CI 2.11‐11.78, P < .001) controlling for age, severe CDI, and pre‐SOT CDI. Post‐SOT CDI nearly doubled the risk of mortality at one year, in particular among those with severe CDI. Conclusions In summary, CDI is highly prevalent, occurs early in the post‐transplant period, usually severe, with a high rate of recurrence, and associated with increased mortality within 1 year after transplant. The early post‐transplant period may be a crucial window to reduce CDI rates.

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Section: Discussionmentioning

confidence: 99%

Clostridioides difficile infection and recurrence among 2622 solid organ transplant recipients

Schluger

Rosenblatt

Knotts

et al. 2019

Transplant Infectious Dis

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“…Age-stratified subgroup analysis revealed that there were significant associations of PPI use with increased initial CDI in both adult (OR 2.30, 95% CI 1.89-2.80) and pediatric (OR 3.00, 95% CI 1.44-6.23) patients. As shown in Table 1, several meta-analyses suggested that PPI use significantly increased the risk of primary/recurrent CDI [21,22] and hospital-acquired CDI [23]. Leonard et al [18] reviewed 6 studies including 11,280 patients with Salmonella , Campylobacter , C. difficile , and other enteric infections, and showed that there was an increased risk of PPI use in those with enteric infections (OR 3.33, 95% CI 1.84-6.02).…”

Section: Infectious and Inflammatory Diseases Possibly Associated Witmentioning

confidence: 99%

Intestinal Dysbiosis Secondary to Proton-Pump Inhibitor Use

Naito

Kashiwagi²,

Takagi³

et al. 2018

Digestion

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Background: Gut dysbiosis associated with the use of proton-pump inhibitors (PPIs) has been found to lead to the occurrence of infectious and inflammatory adverse events. A longitudinal observational cohort study has demonstrated the heightened risk of death associated with PPI use. Summary: We evaluated meta-analyses to determine the association between PPI use and infectious and inflammatory diseases. Meta-analyses showed that PPI use is a potential risk for the development of enteric infections caused by Clostridium difficile, as well as small intestinal bacterial overgrowth, spontaneous bacterial peritonitis, community-acquired pneumonia, hepatic encephalopathy, and adverse outcomes in inflammatory bowel disease. We also examined changes in the composition and function of the gut microbiota with the use of PPIs. PPI use significantly increased the presence of Streptococcaceae and Enterococcaceae, which are risk factors for C. difficile infection, and decreased that of Faecalibacterium, a commensal anti-inflammatory microorganism. Key Message: High-throughput, microbial 16S rRNA gene sequencing has allowed us to investigate the association between the gut microbiome and PPI use. Future prospective comparison studies are necessary to confirm this association, and to develop new strategies to prevent complications of PPI use

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“…A meta-analysis of 50 controlled observational studies showed a significant association between acid suppressant therapy use and risk of developing C. difficile infection (CDI) (odds ratio [OR] 1.26) [11]. Also, a systematic review and meta-analysis of 16 observational studies showed that patients under PPI therapy had an increased risk of recurrent CDI with an OR of 1.52, even after adjustment for age and other potential confounders [12]. Even though the current evidence seems consensual in establishing an association between PPI use and CDI, the risk associated with PPIs is only modest when compared to other drugs, like antibiotics [13].…”

Section: Proposed Side Effects Of Ppismentioning

confidence: 99%

Proton Pump Inhibitors: Are They a Real Threat to the Patient?

Xavier¹,

Magalhães²,

Cotter³

2018

GE Port J Gastroenterol

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Background: Proton pump inhibitors are among the most frequently prescribed drugs in the world and are generally considered safe. However, there is growing concern regarding their safety. Summary: A nonsystematic review of the current literature was performed regarding proton pump inhibitors and their adverse effects. Proton pump inhibitors seem to be associated with fundic gland polyp development (without clinical relevance) and Clostridium difficile infection. Also, in cirrhotic patients, their prescription should be carefully reviewed. Regarding their association with other enteric infections, micronutrient deficiency, dementia, and chronic kidney disease, current evidence is still of low quality, and further studies are needed. Key Messages: Considering the current evidence, most patients with a clear clinical indication for proton pump inhibitor treatment should probably benefit from the maintenance of their treatment without significant adverse effects. However, higher-quality studies are needed to confirm or dismiss most of the proposed adverse effects.

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Association of Gastric Acid Suppression With Recurrent Clostridium difficile Infection

Cited by 136 publications

References 48 publications

Clostridioides difficile infection and recurrence among 2622 solid organ transplant recipients

Clostridioides difficile infection and recurrence among 2622 solid organ transplant recipients

Intestinal Dysbiosis Secondary to Proton-Pump Inhibitor Use

Proton Pump Inhibitors: Are They a Real Threat to the Patient?

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