Iatrogenic Gastric Acid Suppression and the Risk of Nosocomial Clostridium difficile Infection

Howell, Michael D.; Novack, Victor; Grgurich, Philip; Soulliard, Diane; Novack, Lena; Pencina, Michael J.; Talmor, Daniel

doi:10.1001/archinternmed.2010.89

Cited by 389 publications

(247 citation statements)

References 45 publications

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“…Altered gut microbiota in obesity was also observed by other researchers, although the observed changes were usually different (11)(12)(13)(14)(15)(16)(17)(18), and frequently opposite (12)(13)(14)(15)(16)(17)(18) to the observations of Ley et al Note that only three studies stated that the enrolled patients and controls did not take antibiotics in the 3-mo period before sample collection; and all three studies reported an increased Bacteroidetes/Firmicutes ratio in the gut of obese patients (12)(13)(14)19) (Table 1). Our group paid particular attention to proton pump inhibitors and histamine receptor antagonists (14,19) as these agents are known to affect Firmicutes (20). These precautions for patient enrollment gave us confidence in the observed changes in the microbiome of our pediatric NASH patients.…”

Section: Hypothetical Mechanism 1: Elevated Energy Extraction In the mentioning

confidence: 99%

Gut microbiome and nonalcoholic fatty liver diseases

2014

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Section: Hypothetical Mechanism 1: Elevated Energy Extraction In the mentioning

confidence: 99%

Gut microbiome and nonalcoholic fatty liver diseases

2014

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“…[19][20][21] Recent studies have suggested that there is a dose response relationship with administration of PPIs and that risk of Clostridium difficile infection can develop in as soon as three days with PPI therapy. 22,23 Inappropriate administration of high dose PPIs in the ED could place patients at an increased risk for the future development for Clostridium difficile infections later in their hospital course.…”

Section: Discussionmentioning

confidence: 99%

Practical Use of Blactchford Score

Fellows

Rosini

2017

MOJBB

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Aim: To retrospectively evaluate the use of proton pump inhibitor infusions. Methods:A retrospective chart review was conducted of all patients who received an 80 mg bolus of esomeprazole follow by an infusion at 8 mg/hr. An analysis was performed to determine if a Blatchford Score of > 5 was a predictor of upper gastrointestinal ulcers.Results: 300 patients received high dose esomeprazole over a 15 month period. 32% had an ulcer identified on endoscopy. Gastritis and esophagitis were the second most common diagnosis accounting for 16% of patients. A Blatchford Score of >5 as a predictor of upper gastrointestinal ulcers had a sensitivity of 86.5% with a specificity of 32%. Conclusion:Utilizing the Blatchford Score to predict patients that have an upper gastrointestinal ulcer does not appear to be effective in clinical practice.

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“…Par ailleurs, une étude de cohorte américaine a récemment mis en évi-dence une nette augmentation du risque de colite nosocomiale à C. difficile selon un mécanisme dose-dépendant [22].…”

Section: Infections Gastro-intestinales à Clostridium Difficileunclassified

Effets indésirables des inhibiteurs de la pompe à proton : faut-il craindre de les prescrire au long cours ?

Roulet

Vernaz

Giostra

et al. 2012

La Revue de Médecine Interne

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Mots clés :Inhibiteurs de la pompe à proton Fractures ostéoporotiques Infections Cancer gastrique Pharmacodépendance r é s u m é La prévalence des traitements de longue durée par inhibiteurs de la pompe à proton (IPP) est en augmentation. Si leur tolérance à court terme est bonne, des réserves ont vu le jour sur d'éventuels effets indésirables graves associés à une exposition prolongée. Ainsi, l'association avec le risque fracturaire semble être confirmée, notamment au niveau vertébral, ainsi que le risque d'effet rebond sur la sécrétion acide à l'arrêt du traitement. Le risque de pneumopathie communautaire n'est pas établi dans la population générale et semble limité aux patients les plus fragiles. L'association avec le risque d'infection digestive à Clostridium difficile est probable. Les cas de néphrite tubulo-intestitielle sont rares mais peuvent conduire à une insuffisance rénale chronique. Les données disponibles sont encore insuffisantes pour évaluer le risque de carence en vitamine B12, en fer ou en magnésium et le risque de cancer digestif, même si des bases physiopathologiques existent dans le cas du cancer gastrique. Il existe des interactions avec de nombreux autres médicaments, notamment ceux qui sont métabolisés par certaines isoenzymes du cytochrome P450. Enfin, la balance bénéfice-risque de l'utilisation des IPP au long cours chez l'enfant semble défavorable dans la plupart des cas.© 2012 Société nationale française de médecine interne (SNFMI). Publié par Elsevier Masson SAS. Tous droits réservés. Keywords: Proton pump inhibitors Osteoporotic fractures Infection Stomach neoplasms Substance withdrawal syndrome a b s t r a c tLong-term treatment with proton pump inhibitors (PPI) is becoming more prevalent. Although they are well tolerated in the short term, serious concerns about long-term use have arisen. Recent data suggest that the latter is associated with an increased risk for osteoporotic fracture (especially vertebral), Clostridium difficile infection and rebound acid hypersecretion after treatment discontinuation. Acute interstitial nephritis is rare but may progress to chronic renal failure. An increased risk of communityacquired pneumonia has not been established in the general population and seems limited to the most vulnerable patients. Consistent data are still missing to correctly assess the risk of iron deficiency, vitamin B12 deficiency or hypomagnesaemia and the risk of digestive malignant diseases, despite the pathophysiological basis that exists concerning gastric malignancy. Many drug interactions can occur on long-term treatment, including some that imply the cytochrome P450 enzymes. Finally, the risk-benefit balance for a chronic PPI use in children seems unfavorable in most cases.

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Iatrogenic Gastric Acid Suppression and the Risk of Nosocomial Clostridium difficile Infection

Cited by 389 publications

References 45 publications

Gut microbiome and nonalcoholic fatty liver diseases

Gut microbiome and nonalcoholic fatty liver diseases

Practical Use of Blactchford Score

Effets indésirables des inhibiteurs de la pompe à proton : faut-il craindre de les prescrire au long cours ?

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