Increased risk of nosocomial C. difficile infection associated with PPIs

January 01, 0001

Increased risk of nosocomial C. difficile infection associated with PPIs

These US authors conducted a pharmacoepidemiologic cohort study, performing a secondary analysis of data collected prospectively on 101,796 discharges from a tertiary care medical center during a 5-year period. The primary exposure of interest was acid suppression therapy, classified by the most intense acid suppression therapy received - no acid suppression, histamine2-receptor antagonist (H2RA) therapy, daily proton pump inhibitor (PPI), and PPI more frequently than daily.

They found: "As the level of acid suppression increased, the risk of nosocomial C difficile infection increased, from 0.3% in patients not receiving acid suppressive therapy to 0.6% in those receiving H2RA therapy, to 0.9% in those receiving daily PPI treatment, and to 1.4% in those receiving more frequent PPI therapy. After adjustment for comorbid conditions, age, antibiotics, and propensity score-based likelihood of receipt of acid- suppression therapy, the association persisted, increasing from an odds ratio of 1 (no acid suppression [reference

The authors concluded: "Increasing levels of pharmacologic acid suppression are associated with increased risks of nosocomial C difficile infection. This evidence of a dose-response effect provides further support for the potentially causal nature of iatrogenic acid suppression in the development of nosocomial C difficile infection."

This evidence is strong despite the fact that it is not randomized controlled trial data.


For the full abstract, click here.

Arch Intern Med 170(9):784-790, 10 May 2010 © 2010 to the American Medical Association
Iatrogenic Gastric Acid Suppression and the Risk of Nosocomial Clostridium difficile Infection. Michael D. Howell, Victor Novack, Philip Grgurich, et al. Correspondence to Dr. Howell: [email protected]

Category: D. Digestive. Keywords: Clostridium difficile, nosocomial infection, proton pump inhibitors, PPIs, histamine 2 blockers, retrospective cohort study, journal watch.
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 1 June 2010

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.

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