Proton Pump Inhibitors Do Not Increase Risk for Clostridium difficile Infection in the Intensive Care Unit

Faleck, David; Salmasian, Hojjat; Furuya, E. Yoko; Larson, Elaine; Abrams, Julian A.; Freedberg, Daniel E.

doi:10.1038/ajg.2016.343

Cited by 56 publications

(37 citation statements)

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“…Along with previous studies, these data suggest that PPIs do not meaningfully alter clinical outcomes with respect to some of the most important ICU infections: bloodstream infections, VAP, or Clostridium difficile infection. 35 In the ICU setting, any effects of PPIs may simply be too subtle or too short-lived to exert a downstream effect on risk for BSI or other infections.…”

Section: Discussionmentioning

confidence: 99%

Prophylaxis for Stress Ulcers With Proton Pump Inhibitors Is Not Associated With Increased Risk of Bloodstream Infections in the Intensive Care Unit

Cohen

Hathway

Salmasian

et al. 2017

Clinical Gastroenterology and Hepatology

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Background & Aims Proton pump inhibitors (PPIs) have been associated with increased risk of infection, likely due to changes in intestinal epithelial permeability and the gastrointestinal microbiome. PPIs are frequently given to patients in the intensive care unit (ICU) to prevent stress ulcers. These patients are at risk for bloodstream infections (BSIs), so we investigated the relationship between PPI use and BSIs among patients in the ICU. Methods We performed a retrospective cohort study of adults (≥18 years) admitted to 1 of 14 ICUs within a hospital network of 3 large hospitals from 2008 through 2014. The primary exposure was PPI use for stress ulcer prophylaxis in the ICU. The primary outcome was BSI, confirmed by culture analysis, arising 48 hrs or more after admission to the ICU. Subjects were followed for 30 days after ICU admission or until death, discharge, or BSI. Multivariable Cox proportional-hazards modeling was used to test the association between PPIs and BSI, after controlling for patient comorbidities and other clinical factors. Results We analyzed data from 24,774 patients in the ICU, including 756 patients (3.1%) who developed BSIs while in the ICU. The cumulative incidence of BSI was 3.7% in patients with PPI exposure compared to 2.2% in patients without PPI exposure (log-rank test P<.01). After adjusting for potential confounders, PPI exposure was not associated with increased risk of BSI while in the ICU (adjusted hazard ratio, 1.08; 95% CI, 0.91–1.29). Comorbidities, antibiotic use, and mechanical ventilation were all independently associated with increased risk for BSIs. Conclusion In a retrospective study of patients in the ICU, administration of PPIs to prevent bleeding was not associated with increased risk of BSI. These findings indicate that concern for BSI should not affect decisions regarding use of PPIs in the ICU.

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Section: Discussionmentioning

confidence: 99%

Prophylaxis for Stress Ulcers With Proton Pump Inhibitors Is Not Associated With Increased Risk of Bloodstream Infections in the Intensive Care Unit

Cohen

Hathway

Salmasian

et al. 2017

Clinical Gastroenterology and Hepatology

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“…It has been hypothesized that PPIs alter the colonic flora by facilitating the growth of potentially pathogenic organisms in the gastrointestinal tract . A few studies reported no increased risk of developing CDI if patients are exposed to a PPI . However, significantly more clinical studies found the use of a PPI among hospitalized patients as a risk factor for the development of CDI …”

Section: Discussionmentioning

confidence: 99%

Evaluation of Risk Factors forClostridium difficileInfection in Hematopoietic Stem Cell Transplant Recipients

et al. 2017

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“…While most studies suggest a higher risk for CDI during PPI treatment, there are contradictory reports in literature [19]. Given that acid suppression drugs may be over-prescribed in surgical settings, consideration should be given to stopping PPIs in patients at high risk of CDI [8].…”

Section: Discussionmentioning

confidence: 99%

“…The prophylactic dose given immediately before surgery is associated with dramatically reduced rates of wound infection and post-operative sepsis [18]. It is likely that any slightly increased risk of post-operative CDI associated with such prophylactic use of antibiotics would be outweighed by benefit [8].While most studies suggest a higher risk for CDI during PPI treatment, there are contradictory reports in literature [19]. Given that acid suppression drugs may be over-prescribed in surgical settings, consideration should be given to stopping PPIs in patients at high risk of CDI [8].…”

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Clostridium Difficile Infection - An Optimistic View

Frunza¹,

Rotundu²,

Morărașu³

et al. 2017

Surgery

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Journal of Surgery IntroductionClostridium difficile is an anaerobic, Gram-positive, spore-forming, toxin-producing bacteria identified as a cause of colitis associated with antibiotic use [1]. Previous exposure to antibiotics is the most important risk factor for CDI, leading to modification of the normal flora of the colon and decreasing the intestine's resistance to colonization [2]. Other risk factors for CDI are inflammatory bowel disease, immunodeficiency, hypoalbuminemia, malignancies, organ transplantation and mechanical bowel preparation. Despite the development of CDI therapy there is a growing incidence, severity, mortality and recurrence of this condition [3]. The high rate of recurrent CDI raises a question mark over current treatment recommendations of the first episodes of CDI [4,5]. Materials and MethodsWe identified all reported cases of CDI during the period of 2014-2016 using the digital database of the center for control, surveillance, and prevention of transmissible diseases in the Regional Oncologic Institute Iasi. All cases are registered in the database immediately after diagnosis, followed by epidemiological investigation and standardized protocols for isolation and protection of contacts. The admission charts were studied to extract the following information: age, sex, date of admission and release, date of CDI confirmation and toxin negativity. We also checked for antibiotic use in the last 3 months, administration of gastricantisecretory medication, previous hospitalization or contact with CDIconfirmed patients. For the surgical cases we gathered data about the date and type of intervention performed. Diagnosis of Clostridium difficile colitisEven if symptoms can be variable, typical symptom is watery diarrhea up to 15-30 stools per day [1,3]. Some patients can complain AbstractBackground: Clostridium difficile infection (CDI) is one of the most common infectious complications affecting vulnerable patients, i.e., after surgery or immunosuppressive therapies, posing a significant risk in an oncological unit. Materials and methods:We analyzed data recovered from 164 cases of CDI during the period of 2014-2016 in the Regional Oncologic Institute Iasi, majority admitted in the surgical and hematological units. In all cases diagnostic was confirmed if stool samples tested positive for GDH and at least one of the toxins A or B. Results:The study shows a large population of elder patients (median age 64 years) with female dominance (54%). Out of 117 surgical cases 64% had surgical procedures on the gastro-intestinal tract. Although 20% of patients had equivocal symptoms from admission, the average interval (from admission) until first symptoms developed was 7 days. The confirmation of the diagnosis came in the next day/24h in 68% of cases, leading to initiation of efficient therapy. Although CDI is regarded as an antibiotic associated disease, our data revealed that only one third of patients received antibiotic treatment in the last 3 months. Among the risk factors that may have an influen...

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Proton Pump Inhibitors Do Not Increase Risk for Clostridium difficile Infection in the Intensive Care Unit

Cited by 56 publications

References 56 publications

Prophylaxis for Stress Ulcers With Proton Pump Inhibitors Is Not Associated With Increased Risk of Bloodstream Infections in the Intensive Care Unit

Prophylaxis for Stress Ulcers With Proton Pump Inhibitors Is Not Associated With Increased Risk of Bloodstream Infections in the Intensive Care Unit

Evaluation of Risk Factors forClostridium difficileInfection in Hematopoietic Stem Cell Transplant Recipients

Clostridium Difficile Infection - An Optimistic View

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