Inappropriate Use of Gastric Acid Suppression Therapy in Hospitalized Patients with Clostridium difficile—Associated Diarrhea: A Ten-Year Retrospective Analysis

Abstract

Purpose. The incidence of Clostridium difficile-associated diarrhea (CDAD) has steadily increased over the past decade. A multitude of factors for this rise in incidence of CDAD have been postulated, including the increased use of gastric acid suppression therapy (GAST). Despite the presence of practice guidelines for use of GAST, studies have demonstrated widespread inappropriate use of GAST in hospitalized patients. We performed a retrospective analysis of inpatients with CDAD, with special emphasis placed on determining the appropriateness of GAST. Methods. A retrospective analysis was conducted at a multidisciplinary teaching hospital on inpatients with CDAD over a 10-year period. We assessed the use of GAST in the cases of CDAD. Data collection focused on the appropriate administration of GAST as defined by standard practice guidelines. Results. An inappropriate indication for GAST was not apparent in a majority (69.4%) of patients with CDAD. The inappropriate use of GAST was more prevalent in medical (86.1%) than on surgical services (13.9%) (P < 0.001). There were more cases (67.6%) of inappropriate use of GAST in noncritical care than in critical care areas (37.4%) (P < 0.001). Conclusion. Our study found that an inappropriate use of inpatient GAST in patients with CDAD was nearly 70 percent. Reduction of inappropriate use of GAST may be an additional approach to reduce the risk of CDAD and significantly decrease patient morbidity and healthcare costs.

Proton pump inhibitors therapy and risk of Clostridium difficile infection: Systematic review and meta-analysis

“…It should be mentioned that PPIs continue to be among the most used drugs despite the above mentioned concerns about long-term side effects. Furthermore, beside a marked overuse of PPIs, over half of prescriptions are for non-indicated reasons[ 29 ]. One study reported that 60.7% of patients with CDI used PPIs, of whom only 47.1% had an evidence-based indication[ 30 ].…”

Fidaxomicin in the treatment of colitis due to Clostridium difficile: preliminary results

“…La letteratura è univoca nel considerare le CDI sequele del trattamento antibiotico [2,4,10,38,39,[42][43][44][45][46][52][53][54] e antisecretivo gastrico [47][48][49][50][52][53][54], singoli o associati, e dello status nutrizionale-immunologico del paziente [55,56].…”

“…viduati numerosi fattori di rischio quali età [37,38], impegno clinico [2,4,10,38,39], durata del ricovero [40,41], assetto nutrizionale e soprattutto terapia antibiotica [42][43][44][45][46], impiego degli inibitori di pompa protonica [47][48][49][50] (Proton Pump Inhibitors -PPI), ricovero in strutture sanitarie riabilitative o per lungodegenti [51]. La storia naturale dell'infezione intestinale da C. difficile è ben conosciuta [52][53][54].…”

Educational intervention can improve appropriateness of acid suppression therapy in hospitalized geriatric patients

“…Additionally, once initiated during hospitalization, there is a high likelihood these medications will be continued at the time of the discharge [12]. Accepted indications have been outlined by the USA Food and Drug Administration (USFDA) and the American Society of Health System Pharmacists (ASHP) for the use of PPIs (Tables 1 and 2) [13][14][15][16][17].…”