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Continuous Proton Pump Inhibitor Therapy and the Associated Risk of Recurrent Clostridium difficile Infection.
- Source :
-
JAMA internal medicine [JAMA Intern Med] 2015 May; Vol. 175 (5), pp. 784-91. - Publication Year :
- 2015
-
Abstract
- Importance: Clostridium difficile infection (CDI) is associated with significant morbidity, mortality, and a high risk of recurrence. Proton pump inhibitor (PPI) use is associated with an initial episode of CDI, and PPIs are frequently overprescribed. For many, the use of PPIs could likely be discontinued before CDI recurrence.<br />Objectives: To determine whether PPI use was associated with a risk of initial CDI recurrence, to assess what proportion of patients who developed CDI were taking a PPI for a non-evidence-based indication, and to evaluate whether physicians discontinued unnecessary PPIs in the context of CDI.<br />Design, Setting, and Participants: We conducted a retrospective cohort study of incident health care-associated CDI cases to determine the association between continuous PPI use and CDI recurrence within 90 days. The setting was 2 university-affiliated hospitals, the 417-bed Montreal General Hospital (Montreal, Quebec, Canada) and the 517-bed Royal Victoria Hospital (Montreal, Quebec, Canada). The cohort consisted of 754 patients who developed health care-associated CDI between January 1, 2010, and January 30, 2013, and who survived for a minimum of 15 days after their initial episode of nosocomial CDI.<br />Exposure: Continuous PPI use.<br />Main Outcomes and Measures: Recurrence of CDI within 15 to 90 days of the initial episode.<br />Results: Using a multivariable Cox proportional hazards model, the cause-specific hazard ratios for recurrence were 1.5 (95% CI, 1.1-2.0) for age older than 75 years, 1.5 (95% CI, 1.1-2.0) for continuous PPI use, 1.003 (95% CI, 1.002-1.004) per day for length of stay, and 1.3 (95% CI, 0.9-1.7) for antibiotic reexposure. The use of PPIs was common (60.7%), with only 47.1% of patients having an evidence-based indication. Proton pump inhibitors were discontinued in only 3 patients with CDI.<br />Conclusions and Relevance: After adjustment for other independent predictors of recurrence, patients with continuous PPI use remained at elevated risk of CDI recurrence. We suggest that the cessation of unnecessary PPI use should be considered at the time of CDI diagnosis.
- Subjects :
- Age Factors
Aged
Canada epidemiology
Female
Humans
Incidence
Length of Stay statistics & numerical data
Male
Middle Aged
Retrospective Studies
Risk Factors
Withholding Treatment
Anti-Bacterial Agents classification
Anti-Bacterial Agents therapeutic use
Clostridioides difficile drug effects
Clostridium Infections diagnosis
Clostridium Infections epidemiology
Clostridium Infections etiology
Clostridium Infections physiopathology
Clostridium Infections therapy
Cross Infection diagnosis
Cross Infection epidemiology
Cross Infection etiology
Cross Infection physiopathology
Cross Infection therapy
Inappropriate Prescribing adverse effects
Inappropriate Prescribing prevention & control
Inappropriate Prescribing statistics & numerical data
Proton Pump Inhibitors therapeutic use
Secondary Prevention methods
Secondary Prevention statistics & numerical data
Subjects
Details
- Language :
- English
- ISSN :
- 2168-6114
- Volume :
- 175
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- JAMA internal medicine
- Publication Type :
- Academic Journal
- Accession number :
- 25730198
- Full Text :
- https://doi.org/10.1001/jamainternmed.2015.42