Proton pump inhibitors as a risk factor for Clostridium difficile diarrhoea

Thomalla

Journal of Medical Microbiology

et al. 2005

Antibiotic-associated diarrhoea (AAD) represents a clinical entity leading to prolonged hospital stays and diagnostic and therapeutic procedures, and results in additional costs. The aim of the present study was to assess the prevalence and characteristics of different bacteria in stools of patients with AAD. The reliability of diagnostic procedures under routine conditions was evaluated. Host factors were also analysed. From June 2002 to April 2003 89 cases of diarrhoea were reported at a hospital unit for internal medicine. Clostridium difficile and Clostridium perfringens toxin enzyme-immunoassays (EIAs), and culture for C. difficile, C. perfringens and Staphylococcus aureus were performed on stool samples from all patients. Toxin production was determined in isolated S. aureus strains. In vitro susceptibility of S. aureus for oxacillin and of C. difficile for vancomycin, metronidazole, linezolid, fusidic acid and tetracycline was tested. Host factors, such as age, comorbidities, antibiotic exposure and contact with other patients, were evaluated. Twenty-six stools were positive for C. difficile toxins by an EIA technique, while C. difficile was cultured from 39. C. difficile was isolated from 21 stools that were EIA negative. Additionally, from 28 stools S. aureus and/or C. perfringens could be isolated. Nine samples contained only S. aureus and/or C. perfringens. Thirty-one stools were negative in all tests. All C. difficile isolates were susceptible to vancomycin and metronidazole. Age .60 years, and diseases of the vascular system, the heart, the kidneys and the lungs were identified as risk factors for acquiring C. difficile in this setting (P values , 0 . 05). Stool culture for C. difficile was shown to be more sensitive than toxin EIA in this study. Risk factors for the acquisition of C. difficile in outbreak situations seem to differ from risk factors in the normal hospital setting. The role of toxin-producing S. aureus in cases of AAD needs further investigation.

Section: Discussioncontrasting

confidence: 63%

Prevalence and characteristics of bacteria and host factors in an outbreak situation of antibiotic-associated diarrhoea

Thomalla

Journal of Medical Microbiology

et al. 2005

“…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.…”

Section: Introductionmentioning

confidence: 99%

“…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.…”

Section: Introductionmentioning

confidence: 99%

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

Dalton

Lye-Maccannell

Henderson

et al. 2009

Aliment Pharmacol Ther

“…This practice is unjustified, and there is no evidence-based data that support the continuation of AST at discharge [57,58] . Furthermore, long-term use of acid-suppression medications was associated with an increase in unnecessary expenses [47,57] , and most importantly with an increased risk of pneumonia [59] , hip fracture [60] and Clostridium difficile colitis [61,62] . In order to explore whether teaching hospitals are more compliant with SUP guidelines, patients were stratified into two groups, resulting in statistically significant differences: a higher proportion of inpatients in teaching healthcare centers received adequate prophylaxis compared to patients in non-teaching hospitals.…”

mentioning

confidence: 99%

Stress ulcer prophylaxis guidelines: Are they being implemented in Lebanese health care centers?

Zeitoun

Zeineddine²,

Dimassi³

2011

WJGPT

AIM:To evaluate the current practice of stress ulcer prophylaxis (SUP) in Lebanese Health care centers. METHODS:A multi-center prospective chart review study was conducted over 8 mo. A questionnaire was distributed to pharmacy students who collected data on demographics, SUP medications, dose, route, duration and associated risk factors. The appropriateness of SUP use was determined as per American Society of Health-System Pharmacists guidelines. Institutional review board approval was obtained from each hospital center. RESULTS:A total of 1004 patients were included. 67% of the patients who received prophylaxis did not have an indication for SUP. The majority (71.6%) of the patients who were administered parenteral drugs can tolerate oral medications. Overall, the regimen of acid-suppressant drugs was suboptimal in 87.6% of the sample. This misuse was mainly observed in nonteaching hospitals. CONCLUSION:This study highlighted the need, in Lebanese hospitals, to establish clinical practice guidelines for the use of SUP; mainly in non-critical care settings.