Risk of Clostridium difficile diarrhea among hospital inpatients prescribed proton pump inhibitors: cohort and case-control studies

Proton pump inhibitors increase significantly the risk of Clostridium difficile infection in a low‐endemicity, non‐outbreak hospital setting

“…In two case control studies, LOS, defined in the same manner as in this study, was found to be significantly inversely correlated with CDI risk in adjusted analyses. 6,13 Most recent studies assessing risk of CDI in hospital did not include a measure of LOS in the analysis, but Dubberke et al, 19 found LOS of 4.5-7.5 and >7.5 days was incrementally associated with CDI. As our patients all had ‡7 day LOS as an inclusion criteria, the results of Dubberke et al do not necessarily contradict but suggests risk may plateau with LOS >7 or 7.5 days.…”

“…10 Changes to existing PPI prescribing practices might be warranted if exposure increases the risk or severity of CDI by a clinically relevant magnitude. A relationship between PPI use and CDI risk has been both supported [11][12][13][14][15][16][17][18][19][20] and refuted 6,[21][22][23] by recent epidemiological studies. Several of these studies were conducted during hospital outbreaks of the NAP1 strain.…”

“…Several of these studies were conducted during hospital outbreaks of the NAP1 strain. 6,12,13,17,22,23 Two studies have examined the association of PPI to CDI in an endemic hospital setting; 16,19 others did not describe the epidemiology of CDI in the hospital 11,18 or were community-based studies. 14,15,21 The rate of new CDI cases in Calgary, Alberta, Canada at three acute adult hospitals is low compared to that in Quebec, ranging from 1.0 to 2.9 cases ⁄ 1000 admissions during the period from 2003 to 2007.…”

Probiotics for recurrent Clostridium difficile disease

“…Although our study was not powered to detect a difference in outcomes for RCDAD, the data spotlight several feasibility challenges relevant to the launch of a large-scale probiotic efficacy trial. First, the majority of participants were prescribed concurrent systemic antimicrobial therapy for non-CDAD indications and gastric acid suppressive therapy, both of which interfere with the normal gut flora and its ability to inhibit C. difficile colonization (McFarland, 2005;Dial et al, 2004). Avoidance of these drugs is often not feasible in frequently hospitalized older adults with multiple comorbidities, thus introducing an important source of confounding that can be difficult to quantify.…”

Characteristics of Clostridium difficile infection in a high complexity hospital and report of the circulation of the NAP1/027 hypervirulent strain in Colombia

“…En esta serie de casos, se detectaron factores relacionados con la infección por C. difficile como la edad avanzada, el uso de antibióticos, la hospitalización previa, el uso de inhibidores de la bomba de protones y la comorbilidad, lo cual concuerda con lo reportado ampliamente en otros estudios (12,(20)(21)(22)(23). En 2001, Fernández-Caniggia, et al, (24) reportaron la edad avanzada, las comorbilidades, la hospitalización, el tratamiento antimicrobiano y la inmunosupresión reciente, como factores asociados a la infección por C. difficile en una serie de 245 pacientes en Argentina (25).…”