title: Proton pump inhibitors increase significantly the risk of Clostridium difficile infection in a low-endemicity, non-outbreak hospital setting.
abstract: BACKGROUND
  Proton pump inhibitors (PPI) have been linked to higher risk of Clostridium difficile infection (CDI). The relevance of this association in hospitals with low disease activity, where an outbreak strain is nondominant, has been assessed in relatively few studies.
  
  
  OBJECTIVE
  To assess the association of PPI and CDI in a setting of low disease activity.
  
  
  METHODS
  A retrospective cohort study was conducted at two hospitals. Patients admitted for > or = 7 days receiving antibiotics were included. Demographics, exposure to PPI, antibiotics and other drugs in relation to diagnosis of CDI were assessed by univariate and multivariate analyses.
  
  
  RESULTS
  Of 14 719 patients, 149 (1%) first episode CDI were documented; PPI co-exposure increased CDI [1.44 cases/100 patients vs. 0.74 cases/100 non-exposed (OR: 1.96, 95% CI: 1.42-2.72)]. By logistic regression, PPI days (adjusted OR: 1.01 per day, 95% CI: 1.00-1.02), histamine-2 blockers, antidepressants, antibiotic days, exposure to medications, age, admission service and length of admission were significant predictors.
  
  
  CONCLUSIONS
  A statistically significant increase in CDI was observed in antibiotic recipients who received PPI, but the absolute risk increase is modest. In settings of with low rates of CDI, the benefit of PPI therapy outweighs the risk of developing CDI. These data support programmes to decrease inappropriate use of PPI in hospitalized patients.
authors.affiliation: Department of Pharmacy Services, Calgary Health Region, Calgary, AB, Canada. bruce.dalton@albertahealthservices.ca
authors.forename: B R
authors.initials: BR
authors.lastname: Dalton
authors.forename: T
authors.initials: T
authors.lastname: Lye-Maccannell
authors.forename: E A
authors.initials: EA
authors.lastname: Henderson
authors.forename: D R
authors.initials: DR
authors.lastname: Maccannell
authors.forename: T J
authors.initials: TJ
authors.lastname: Louie
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016360:Clostridioides difficile / Q000187:drug effects*; D003015:Clostridium Infections / Q000453:epidemiology*; D003428:Cross Infection / Q000139:chemically induced*; D004196:Disease Outbreaks; D004812:Epidemiologic Methods; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D054328:Proton Pump Inhibitors / Q000009:adverse effects*
chemical_list: D054328:Proton Pump Inhibitors