Overuse of Vitamin B12 Supplementation in French Nursing Homes

Abstract

The number of subjects treated using a PPI was similar between CDI cases (50%) and controls (48%) (P = .81). PPI dose was also similar in both groups (Table 1). When age, sex, number of comorbidities, main reason for admission, place of residence, PPI use, antibiotic use, glucocorticoid therapy, severe anemia (hemoglobin <10 g/dL), and chronic kidney failure (eGFR < 30 mL/min) were added in a stepwise logistic regression model, only severe anemia was an independent risk factor for CDI (odds ratio = 2.8, 95% confidence interval = 1.3-5.9). DISCUSSIONPPI use was not found to be a risk factor for nosocomial CDI. Almost 90% of subjects used high-risk antibiotics, which is similar to the results of two studies in which subjects were matched for antibiotic use. 6,7 A similar number of CDI-positive individuals and controls were prescribed a PPI. Multiple studies have demonstrated that PPI use is a risk factor for CDI, 2,3,6,7 but other studies did not find a clear association after adjustment for coexisting conditions. 4,8,9 A recent meta-analysis of 47 studies showed that the quality of evidence supporting an association between PPI use and CDI risk was very low. 10 Studies in frail elderly adults are rare. A retrospective study concluded that suppression of gastric acid secretion did not increase the risk of CDI in hospitalized elderly adults (mean age 82). 8 A study comparable with the current one (mean age 72) found significantly higher PPI use in individuals with CDI than controls. 7 PPI use was not associated with high risk for nosocomial CDI in older adults. Subjects who developed CDI had a significantly longer hospital stay and higher in-hospital mortality. Only severe anemia was found to be an independent risk factor for CDI.