Reply to Wiegand et al.: Proton pump inhibitor over-use and the ongoing battle to control Clostridium difficile infection in hospitals (original) (raw)
Related papers
Risk of clostridium difficile infection with acid suppressing drugs and antibiotics: Meta-analysis
American Journal of Gastroenterology, 2012
Several studies have raised concern regarding the possible association between proton-pump inhibitors (PPIs) and Clostridium diffi cile infection (CDI). We aimed to perform a systematic review of incident and recurrent CDI in PPI users, and to evaluate the relative impact of concurrent antibiotic use, or switching acid suppression to histamine-2-receptor antagonists (H2RAs).
The American journal of gastroenterology, 2016
Patients in the intensive care unit (ICU) frequently receive proton pump inhibitors (PPIs) and have high rates of Clostridium difficile infection (CDI). PPIs have been associated with CDI in hospitalized patients, but ICU patients differ fundamentally from non-ICU patients and few studies have focused on PPI use exclusively in the critical care setting. We performed a retrospective cohort study to determine the associations between PPIs and health-care facility-onset CDI in the ICU. We analyzed data from all adult ICU patients at three affiliated hospitals (14 ICUs) between 2010 and 2013. Patients were excluded if they had recent CDI or an ICU stay of <3 days. We parsed electronic medical records for ICU exposures, focusing on PPIs and other potentially modifiable exposures that occurred during ICU stays. Health-care facility-onset CDI in the ICU was defined as a newly positive PCR for the C. difficile toxin B gene from an unformed stool, with subsequent receipt of anti-CDI thera...
Proton pump inhibitors and risk for Clostridium difficile associated diarrhea
Increased incidence of Clostridium difficile infection (CDI) among in-patients is associated with significant increased mortality, morbidity, and stay in the hospitals. This has occurred despite heightened awareness of the risks of broad-spectrum antibiotics, overall reduction in antibiotic use and increased focus on hospital hygiene. So though the main risk factor for CDI is use of broad-spectrum antibiotics, the use of proton pump inhibitors (PPIs) as a novel potential contributor has been implicated, because of their ability to substantially reduce gastric acid secretion which is an important host defense mechanism in suppressing the ingested C. difficile or its spores. Antibiotic disruption of the normal intestinal flora and reduced gastric acidity have been suggested as the risk factors for C. difficile-associated diarrhea (CDAD). Based on such assumptions the use of PPIs may be associated with an increased risk of CDAD. While a definite association between PPI use and CDAD has not yet been confirmed, the possibility and such an association however cannot be ruled out at present. Thus among the identified risk factors, the use of PPI is important, previously unrecognized and modifiable risk factors whose use should be carefully evaluated among hospital in-patients receiving antibiotics, especially in those with a diagnosis of C. difficile diarrhea.
Canadian Medical Association Journal, 2006
R ecent reports have indicated that the use of proton pump inhibitors may increase the risk of severe infections, 1-5 including Clostridium difficile-associated disease (CDAD). In a recent study using the United Kingdom's General Practice Research Database (GPRD), cases of CDAD were defined on the basis of a laboratory diagnosis (a positive toxin assay result) or a physician's diagnosis. 1 However, a clinical diagnosis without a record of a laboratory confirmation has been criticized. It is possible that patients with a clinical diagnosis of CDAD were positive for the toxin but that their physician had not recorded the laboratory result in the database. Since March 2002 there have been changes in the UK health care system and GPRD in the reporting of CDAD, and laboratory results are now transferred electronically directly into the database. 6,7 These changes have increased the proportion of cases being diagnosed on the basis of a positive toxin assay result. We thus reexamined the association between gastric acid suppressive therapy (in particular, proton pump inhibitors) and the risk of CDAD using an alternative outcome definition for CDAD that is less likely to be affected by a recording bias, namely a prescription for oral vancomycin therapy, whose only indication is the treatment of CDAD. 8,9 This definition also implies that these would be clinically relevant cases of CDAD. Methods We obtained data from the United Kingdom's GPRD. The GPRD is the world's largest and most comprehensive computerized database of anonymous longitudinal medical records from primary care (www.gprd.com) and has been used worldwide for research. Data are collected for over 3 million active patients (about 9 million total) from about 400 primary care practices throughout the United Kingdom. It has been demonstrated that there is good agreement between GPRD data and prescribing data and national data from the Prescription Pricing Authority (based on dispensing). 10 Primary care practices are required to record a minimum of 95% of prescriptions and relevant encounters with patients. Data from practices are routinely validated by internal checks. Only data meeting the minimum standards are added to the research database, and practices that fail to meet the required standards