Exposure to Gastric Acid–Suppression Therapy Is Associated With Health Care– and Community‐Associated <i>Clostridium difficile</i> Infection in Children

Jimenez, Jennifer; Drees, Marci; Loveridge-Lenza, Beth; Eppes, Stephen C.; delRosario, Fernando

doi:10.1097/mpg.0000000000000790

Cited by 30 publications

(9 citation statements)

References 21 publications

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“…19 Several studies of CDI in children support our findings that recent exposure to gastric acid-suppression medications is associated with CA-CDI. 7,20,21 We found that the odds of CA-CDI development following proton pump inhibitor and H2 receptor antagonist exposure were similar to that seen with antibiotic exposures. Given the high frequency with which these medications are prescribed in pediatrics for conditions such as physiologic reflux, these exposures may be a contributor to the increasing number of CA-CDI cases seen in children.…”

Section: Discussionsupporting

confidence: 55%

Risk Factors for Community-Associated Clostridium difficile Infection in Children

Adams

Eberly

Rajnik

et al. 2017

The Journal of Pediatrics

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Section: Discussionsupporting

confidence: 55%

Risk Factors for Community-Associated Clostridium difficile Infection in Children

Adams

Eberly

Rajnik

et al. 2017

The Journal of Pediatrics

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“…Rationale: Stress ulcer prophylaxis should not be routinely administered to children with septic shock or other sepsis-associated organ dysfunction, as evidence for benefit is lacking [497] and may increase risk of adverse effects, such as pneumonia or C. difficile (formerly Clostridium) infection [498]. Rather than routine, universal administration of stress-ulcer prophylaxis, individual patients should be assessed for the presence of risk factors of clinically important gastrointestinal bleeding.…”

Section: Prophylaxismentioning

confidence: 99%

Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children

et al. 2020

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Objectives: To develop evidence-based recommendations for clinicians caring for children (including infants, school-aged children, and adolescents) with septic shock and other sepsis-associated organ dysfunction.Design: A panel of 49 international experts, representing 12 international organizations, as well as three methodologists and three public members was convened. Panel members assembled at key international meetings (for those The Society of Critical Care Medicine guidelines are intended for general information only, are not medical advice, and do not replace professional advice, which should be sought for any medical condition. The full disclaimer for guidelines can be accessed at https ://www.sccm.org/Resea rch/Guide lines /Guide lines . panel members attending the conference), and a stand-alone meeting was held for all panel members in November 2018. A formal conflict-of-interest policy was developed at the onset of the process and enforced throughout. Teleconferences and electronic-based discussion among the chairs, co-chairs, methodologists, and group heads, as well as within subgroups, served as an integral part of the guideline development process. Methods:The panel consisted of six subgroups: recognition and management of infection, hemodynamics and resuscitation, ventilation, endocrine and metabolic therapies, adjunctive therapies, and research priorities. We conducted a systematic review for each Population, Intervention, Control, and Outcomes question to identify the best available evidence, statistically summarized the evidence, and then assessed the quality of evidence using the Grading of Recommendations Assessment, Development, and Evaluation approach. We used the evidence-to-decision framework to formulate recommendations as strong or weak, or as a best practice statement. In addition, "in our practice" statements were included when evidence was inconclusive to issue a recommendation, but the panel felt that some guidance based on practice patterns may be appropriate. Results:The panel provided 77 statements on the management and resuscitation of children with septic shock and other sepsis-associated organ dysfunction. Overall, six were strong recommendations, 49 were weak recommendations, and nine were best-practice statements. For 13 questions, no recommendations could be made; but, for 10 of these, "in our practice" statements were provided. In addition, 52 research priorities were identified. Conclusions:A large cohort of international experts was able to achieve consensus regarding many recommendations for the best care of children with sepsis, acknowledging that most aspects of care had relatively low quality of evidence resulting in the frequent issuance of weak recommendations. Despite this challenge, these recommendations regarding the management of children with septic shock and other sepsis-associated organ dysfunction provide a foundation for consistent care to improve outcomes and inform future research. S14 the group heads, panel members, and methodologists. Searches utilized ...

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“…Several adverse effects might be associated with using AST. The reported adverse effects in pediatric literature include gastroenteritis 29 , pneumonia 24,29 , and Clostridium difficile infection 30,31 with both PPIs and H2RAs. Necrotizing enterocolitis 32 and candidemia 33 has been linked to H2RAs use in neonates and infants.…”

Section: Discussionmentioning

confidence: 99%

Acid Suppression Therapy for the Empirical Treatment of Nausea and Vomiting in Hospitalized Pediatric Patients

Alakeel

Almeshary

Alghamdi

et al. 2021

J. Drug Delivery Ther.

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Objective: To investigate and compare the safety and efficacy of the empirical use of Histamine-2-receptor antagonists (H2RAs) and Proton pump inhibitors (PPIs), for the treatment of unspecified nausea and vomiting (NV) in hospitalized children. Methods: The retrospective cohort study was conducted at King Abdulaziz Medical City in Riyadh (KAMC-R) and included pediatric patients ≤14 years who received acid suppression therapy (AST), H2RAs or PPIs, for the treatment of unspecified NV between April 30, 2018, and April 30, 2019. The primary outcome was the complete resolution of NV within three days of AST. The secondary outcomes were the frequency of rescue medication use, the number of vomiting episodes since starting the AST, and the adverse drug reactions (ADRs). Results: Sixty-two patients were included in the study, 25 (40.3%) were in the H2RAs group and 37 (59.7%) in the PPIs group. The mean age was 3.69 ± 4.13 years, with the majority male (64.5%). Overall, 87% (n=54) of the sample had complete resolution of NV within 3 days of the AST therapy with no difference between the H2RAs and PPIs groups (p=0.344). The number of NV episodes from initiating the AST until the complete resolution was similar between the groups. In total, 14 patients (25.9%) required rescue therapy with granisetron, 6 (26.1%) in the H2RAs group compared to 8 (25.8%) in the PPIs group. There was no difference in the number of the required granisetron doses or the incidence of ADRs. Conclusion: Both PPIs and H2RAs were effective and safe for the treatment of unspecified NV in hospitalized pediatric patients. The selection of either agent should be based on other factors. Keywords: Pediatric; Nausea and vomiting; Proton pump inhibitor; Histamine-2-receptor antagonist; Granisetron.

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Exposure to Gastric Acid–Suppression Therapy Is Associated With Health Care– and Community‐Associated Clostridium difficile Infection in Children

Abstract: Gastric acid-suppression therapy was associated with both health care- and community-associated CDIs in children. Larger pediatric studies are necessary to determine the role of proton pump inhibitors specifically in causing CDI in children.

Cited by 30 publications

References 21 publications

Risk Factors for Community-Associated Clostridium difficile Infection in Children

Risk Factors for Community-Associated Clostridium difficile Infection in Children

Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children

Acid Suppression Therapy for the Empirical Treatment of Nausea and Vomiting in Hospitalized Pediatric Patients

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