Effects of proton pump inhibitor use on risk of Clostridium difficile infection: a hospital cohort study

Background Although there are several studies on the association between use of proton pump inhibitors (PPIs) and increased Clostridium difficile infection (CDI) risk, detailed studies analyzing the effects of PPI use on CDI risk are lacking. The present study investigated the association of the dos...

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Bibliographic Details
Published in:Journal of gastroenterology 2019-12, Vol.54 (12), p.1052-1060
Main Authors: Park, Yoon Hee, Seong, Jong Mi, Cho, Soyeon, Han, Hye Won, Kim, Jae Youn, An, Sook Hee, Gwak, Hye Sun
Format: Article
Language:English
Subjects:
Abdominal Surgery
Clostridium difficile
Cohort analysis
Colorectal Surgery
Drug dosages
Gastroenterology
Health aspects
Hepatology
Infection
Medical research
Medicine
Medicine & Public Health
Medicine, Experimental
Omeprazole
Original Article—Alimentary Tract
Pantoprazole
Proton pump inhibitors
Surgical Oncology
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Summary:Background Although there are several studies on the association between use of proton pump inhibitors (PPIs) and increased Clostridium difficile infection (CDI) risk, detailed studies analyzing the effects of PPI use on CDI risk are lacking. The present study investigated the association of the dose, duration, and types of PPIs with CDI risk. Methods A single-center, cohort study was conducted on patients admitted to a hospital. The exposed cohort comprised patients who were prescribed PPIs at least once during the study period, and a control cohort was prepared by randomly assigning an index date to patients who did not use PPIs ensuring the same distribution of index dates as in the exposed cohort and matching sex, age, hospitalization period, and date of admission. Results PPI use increased the risk of CDI by 1.8-fold [95% confidence interval (CI) 1.5–2.2]. CDI risk increased by 1.8-fold with esomeprazole (95% CI 1.4–2.2) and 2.0-fold with pantoprazole (95% CI 1.5–2.8). Patients who used a high dose had a higher risk than those who used a medium dose [adjusted hazard ratio (HR) 2.0 vs 1.3]. The risk of CDI increased 4.2-fold when the PPI exposure period was 6 days or shorter than 6 days. Conclusions Our study showed that PPI use was associated with an increased risk of developing CDI and the risk of CDI was dose dependent. Therefore, PPIs should only be used at proper doses and only for the necessary indications to avoid CDI risk.
ISSN:0944-1174
1435-5922
DOI:10.1007/s00535-019-01598-2