title: Proton pump inhibitors and hospitalization for Clostridium difficile-associated disease: a population-based study.
abstract: BACKGROUND
  Previous studies have examined the association between proton pump inhibitor (PPI) use and the risk of Clostridium difficile-associated disease (CDAD), with conflicting results. Whether outpatient PPI use influences the risk of hospital admission for CDAD among older patients who have recently been treated with antibiotics is unknown.
  
  
  METHODS
  We conducted a population-based, nested case-control study of linked health care databases in Ontario, Canada, from 1 April 2002 through 31 March 2005. We identified patients aged > or = 66 years who were hospitalized for CDAD within 60 days of receiving outpatient antibiotic therapy. Each case patient with CDAD was matched with 10 control subjects on the basis of age, sex, and details of antibiotic use (antibiotic class, timing, and number of antibiotics used). PPI use by case patients and control subjects was categorized as current (within 90 days), recent (91-180 days), or remote (181-365 days). We used conditional logistic regression to estimate the odds ratio for the association between outpatient PPI use and risk of hospitalization for CDAD.
  
  
  RESULTS
  We identified 1389 case patients and 12,303 matched control subjects. Case patients were no more likely than control subjects to have received a PPI in the preceding 90 days (adjusted odds ratio, 0.9; 95% confidence interval, 0.8-1.1). Similarly, we found no association between hospitalization for CDAD and more remote use of PPIs.
  
  
  CONCLUSIONS
  Among community-dwelling older patients, PPI use is not a risk factor for hospitalization with CDAD.
authors.affiliation: Department of Pharmacy Services, University Health Network, University of Toronto, ON, M5G 2C4, Canada. donna.lowe@uhn.on.ca
authors.forename: Donna O
authors.initials: DO
authors.lastname: Lowe
authors.forename: Muhammad M
authors.initials: MM
authors.lastname: Mamdani
authors.forename: Alexander
authors.initials: A
authors.lastname: Kopp
authors.forename: Donald E
authors.initials: DE
authors.lastname: Low
authors.forename: David N
authors.initials: DN
authors.lastname: Juurlink
mesh_terms: D000368:Aged; D000890:Anti-Infective Agents / Q000627:therapeutic use; D016022:Case-Control Studies; D016360:Clostridioides difficile; D004761:Enterocolitis, Pseudomembranous / Q000188:drug therapy* / Q000191:economics / Q000382:microbiology; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D054328:Proton Pump Inhibitors
chemical_list: D000890:Anti-Infective Agents; D054328:Proton Pump Inhibitors