Proton Pump Inhibitors and Risk for Recurrent Clostridium difficile Infection

Linsky, Amy

doi:10.1001/archinternmed.2010.73

Cited by 253 publications

(166 citation statements)

References 60 publications

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“…Not surprisingly, the risk for rCDI was also greater among patients previously on fluoroquinolones (RR 1.42; 95 % CI 1.28-1.57; P \ .00001) [57]. While Linsky et al found a 42 % increased risk of rCDI with PPI use during incident CDI treatment, a study by Freedberg et al found no such association, instead noting a trend for reduced rCDI with PPI therapy, consistent with reports by Rotramel and colleagues [54,58,59]. Nevertheless, PPIs have been shown to affect the gastric microbiota [60], and a small pilot study recently found that PPI use decreased the diversity of the colonic microbiota [61]; as such, the effects of PPIs on the gut microbiome and rCDI warrant further investigation.…”

Section: Recurrent C Difficile Infection (Rcdi)supporting

confidence: 65%

Recurrent Clostridium difficile infection and the microbiome

2015

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The diverse and densely populated gastrointestinal microbiota is essential for the regulation of host physiology and immune function. As our knowledge of the composition and function of the intestinal microbiota continues to expand, there is new interest in using these developments to tailor fecal microbiota transplantation (FMT) and microbial ecosystem therapeutics (MET) for a variety of diseases. The potential role of FMT and MET in the treatment of Clostridium difficile infection (CDI)-currently the leading nosocomial gastrointestinal infection-has proven highly effective for recurrent CDI, and has emerged as a paradigm shift in the treatment of this disease. The current review will serve as a summary of the key aspects of CDI, and will introduce the essential framework and challenges of FMT, as is currently practiced. MET represents the progression of conventional bacteriotherapy that fundamentally capitalizes on the restorative properties of intestinal bacterial communities and may be viewed as the culmination of a rationally designed therapeutic modality. As our understanding of the composition and function of the intestinal microbiota evolves, it will likely drive next-generation microbiota therapies for a range of medical conditions, such as inflammatory bowel disease, obesity, and metabolic syndrome.

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Section: Recurrent C Difficile Infection (Rcdi)supporting

confidence: 65%

Recurrent Clostridium difficile infection and the microbiome

2015

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“…11,12 Furthermore, other studies have found that, after controlling for important confounders such as age, comorbid conditions, prior history of CDI, antibiotic exposure, and hospitalization, use of PPI or H 2 blockers was not associated with the risk of developing CDI. 13,14 With respect to outcomes, 3 retrospective studies have found an increased risk of recurrent CDI in patients taking a PPI, [15][16][17] although a subgroup analysis of a large randomized controlled trial did not find a difference in the rates of recurrent CDI in patients with or without exposure to PPI and H 2 receptor antagonists. 18 We performed a populationbased study to examine outcomes in patients with CDI who were or were not receiving acid suppression medications at the time of CDI.…”

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confidence: 99%

Gastric Acid Suppression and Outcomes in Clostridium difficile Infection: A Population-Based Study

Khanna

Aronson

Kammer

et al. 2012

Mayo Clinic Proceedings

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Objective: To evaluate the association of gastric acid suppression medications, including proton pump inhibitors and histamine type 2 blockers, with outcomes in patients with Clostridium difficile infection (CDI) in a population-based cohort. Patients and Methods: To understand the association between acid suppression and outcomes in patients with CDI, we conducted a population-based study in Olmsted County, Minnesota, from January 1, 1991, through December 31, 2005. We compared demographic data and outcomes, including severe, severe-complicated, and recurrent CDI and treatment failure, in a cohort of patients with CDI who were treated with acid suppression medications with these outcomes in a cohort with CDI that was not exposed to acid-suppressing agents. Results: Of 385 patients with CDI, 36.4% were undergoing acid suppression (23.4% with proton pump inhibitors, 13.5% with histamine type 2 blockers, and 0.5% with both). On univariate analysis, patients taking acid suppression medications were significantly older (69 vs 56 years; PϽ.001) and more likely to have severe (34.2% vs 23.6%; Pϭ.03) or severecomplicated (4.4% vs 2.6% CDI; Pϭ.006) infection than patients not undergoing acid suppression. On multivariable analyses, after adjustment for age and comorbid conditions, acid suppression medication use was not associated with severe or severecomplicated CDI. In addition, no association between acid suppression and treatment failure or CDI recurrence was found. Conclusion: In this population-based study, after adjustment for age and comorbid conditions, patients with CDI who underwent acid suppression were not more likely to experience severe or severe-complicated CDI, treatment failure, or recurrent infection.

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“…Although generally well tolerated, PPI can cause serious adverse reactions. Their short-term use has been associated with infections such as community-acquired pneumonia [18][19][20][21] or Clostridium difficile diarrhea [22,24] due to low gastric acidity, and with a loss of efficacy of clopidogrel as a result of drug interaction [25][26][27][28][29][30]. Longterm use has been related to increases in hip fractures [31][32][33], delayed diagnosis of gastric cancer and increased risk of all-cause mortality [34,35].…”

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confidence: 99%

Prevalence and appropriateness of drug prescriptions for peptic ulcer and gastro-esophageal reflux disease in a cohort of hospitalized elderly

Pasina

Nobili

Tettamanti

et al. 2011

European Journal of Internal Medicine

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Background: Proton pump inhibitors (PPI) are among the most commonly prescribed medicines and their overuse is widespread in both primary and secondary care. Inappropriate prescription is of particular concern among elderly patients, who have often multiple comorbidities and need many drugs. Methods: We evaluate the appropriateness of drugs for peptic ulcer or gastro-esophageal reflux disease (GERD) in a sample of elderly patients (65 years old or older) at admission and discharge in 38 internal medicine wards between January 2008 and December 2008, according to the presence of specific conditions or gastro-toxic drug combinations. Results: Among 1155 patients eligible for the analysis, 466 (40.3%) were treated with drugs for GERD or peptic ulcer were at hospital admission and 647 (56.0%) at discharge; 62.4% of patients receiving a drug for peptic ulcer or GERD at admission and 63.2% at discharge were inappropriately treated. Among these, the number of other drugs prescribed was associated with greater use of drugs for peptic ulcer or GERD, even after adjustment for age, sex and number of diagnoses at admission (OR 95% CI = 1.26 (1.18-1.34), p = .0001) or discharge (OR 95% CI = 1.11 (1.05-1.18), p = 0.0003). Conclusions: Prevalence of inappropriate prescription of drugs for peptic ulcer or GERD remained almost the same at admission and discharge. Inappropriate use of these drugs is related to the concomitant use of other drugs. Careful assessment of clinical conditions and stricter adherence to evidence-based guidelines are essential for a rational and cost-effective use of drugs for peptic ulcer or GERD.

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Proton Pump Inhibitors and Risk for Recurrent Clostridium difficile Infection

Abstract: Proton pump inhibitor use during incident CDI treatment was associated with a 42% increased risk of recurrence. Our findings warrant further studies to examine this association and careful consideration of the indications for prescribing PPIs during treatment of CDI.

Cited by 253 publications

References 60 publications

Recurrent Clostridium difficile infection and the microbiome

Recurrent Clostridium difficile infection and the microbiome

Gastric Acid Suppression and Outcomes in Clostridium difficile Infection: A Population-Based Study

Prevalence and appropriateness of drug prescriptions for peptic ulcer and gastro-esophageal reflux disease in a cohort of hospitalized elderly

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