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Risk and Severity of Hospital‐Acquired Clostridium difficile Infection in Patients Taking Proton Pump Inhibitors
Author(s) -
Lewis Paul O.,
Litchfield John M.,
Tharp Jennifer L.,
Garcia Rebecca M.,
Pourmorteza Mohsen,
Reddy Chakradhar M.
Publication year - 2016
Publication title -
pharmacotherapy: the journal of human pharmacology and drug therapy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.227
H-Index - 109
eISSN - 1875-9114
pISSN - 0277-0008
DOI - 10.1002/phar.1801
Subject(s) - medicine , clostridium difficile , retrospective cohort study , confidence interval , relative risk , proton pump inhibitor , cohort , cohort study , antibiotics , microbiology and biotechnology , biology
Study Objective To compare the rates and severity of hospital‐acquired Clostridium difficile infection (CDI) among patients taking proton pump inhibitors (PPIs) versus those not taking PPIs. Design Retrospective, single‐center, cohort study. Setting Tertiary community hospital with a teaching service. Patients A total of 41,663 patients with CDI who were hospitalized between January 2013 and May 2014; of those, 17,471 patients (41.9%) had received at least one dose of a PPI (PPI group), and 24,192 patients (58.1%) had no PPI exposure (control group). Measurements and Main Results A total of 348 patients had CDI during the study period, with 269 cases present on admission. Hospital‐acquired CDI was defined as CDI diagnosis occurring on or after the third calendar day of admission. After excluding those patients with CDI on admission, 65 (0.38%) of 17,302 patients later developed CDI in the hospital in the PPI group compared with only 14 (0.058%) of 24,092 patients in the control group. Of these patients, 36 patients (0.21%) in the PPI group met the definition of severe CDI compared with 8 (0.03%) in the control group. This demonstrated an unadjusted relative risk (RR) of 6.46 (95% confidence interval [CI] 3.63–11.51, p<0.0001) of developing hospital‐acquired CDI and an unadjusted RR of 6.27 (95% CI 2.91–13.48, p<0.0001) of developing severe CDI while taking a PPI. When evaluating only patients who developed severe‐complicated CDI, there were 22 cases in the PPI group and 2 cases in the control group, demonstrating an unadjusted RR of 15.3 (95% CI 3.6–65.13, p=0.0002) of developing severe‐complicated CDI. Confounding variables were similar between groups. Conclusion PPI use was associated with an increase in both the rate and severity of hospital‐acquired CDI.