Risk and Severity of Hospital-Acquired Clostridium difficile Infection in Patients Taking Proton Pump Inhibitors

• Published in: Pharmacotherapy 2016-09, Vol.36 (9), p.986-993
• Main Authors: Lewis, Paul O., Litchfield, John M., Tharp, Jennifer L., Garcia, Rebecca M., Pourmorteza, Mohsen, Reddy, Chakradhar M.
• Format: Article
• Language: English
• Subjects: Aged; Clostridium difficile; Confidence intervals; Cross Infection - etiology; Enterocolitis, Pseudomembranous - etiology; Female; gastroenterology; hospital-acquired infection; Humans; infectious disease; Male; proton pump inhibitors; Proton Pump Inhibitors - adverse effects; Retrospective Studies; Risk
• ISSN: 0277-0008; 1875-9114
• DOI: 10.1002/phar.1801

Study Objective To compare the rates and severity of hospital‐acquired Clostridium difficile infection (CDI) among patients taking proton pump inhibitors (PPIs) versus those not taking PPIs. Design Retrospective, single‐center, cohort study. Setting Tertiary community hospital with a teaching service. Patients A total of 41,663 patients with CDI who were hospitalized between January 2013 and May 2014; of those, 17,471 patients (41.9%) had received at least one dose of a PPI (PPI group), and 24,192 patients (58.1%) had no PPI exposure (control group). Measurements and Main Results A total of 348 patients had CDI during the study period, with 269 cases present on admission. Hospital‐acquired CDI was defined as CDI diagnosis occurring on or after the third calendar day of admission. After excluding those patients with CDI on admission, 65 (0.38%) of 17,302 patients later developed CDI in the hospital in the PPI group compared with only 14 (0.058%) of 24,092 patients in the control group. Of these patients, 36 patients (0.21%) in the PPI group met the definition of severe CDI compared with 8 (0.03%) in the control group. This demonstrated an unadjusted relative risk (RR) of 6.46 (95% confidence interval [CI] 3.63–11.51, p