title: Association between proton pump inhibitor use and spontaneous bacterial peritonitis in cirrhotic patients with ascites.
abstract: BACKGROUND
  There are data suggesting a link between proton pump inhibitor (PPI) use and the development of spontaneous bacterial peritonitis (SBP) in cirrhotic patients with ascites; however, these data are controversial.
  
  
  OBJECTIVE
  To assess whether the use of PPIs in cirrhotic patients with ascites is associated with an increased risk for SBP.
  
  
  METHODS
  A retrospective case-control study (June 2004 to June 2010) was conducted at the Centre Hospitalier de l'Université de Montréal in Montreal, Quebec. Fifty-one cirrhotic patients admitted with paracentesis-proven SBP (≥250 neutrophils/mm3), occurring within seven days of hospital admission, met the inclusion criteria. These patients were matched 1:2 (for age, Child-Pugh class and year of admission) with 102 comparable cirrhotic patients with ascites who were admitted for conditions other than SBP.
  
  
  RESULTS
  Patients with SBP had a significantly higher rate of pre-hospital PPI use (60.8%) compared with cirrhotic patients without SBP (42.2%; P=0.03). On multivariate analysis, PPI use was the only factor independently associated with SBP (OR 2.09 [95% CI 1.04 to 4.23]; P=0.04). Thirty-five (35%) patients in both groups had no documented indication for PPI use in their charts. Forty-five percent of the remaining cirrhotic patients with SBP had an inappropriate indication, as defined in the protocol, for PPI use compared with 25% of controls.
  
  
  CONCLUSIONS
  Cirrhotic patients with SBP were twice as likely to have taken PPIs than patients without SBP. These findings reinforce the association between PPI use and SBP observed in other studies. A high percentage of cirrhotic patients were taking a PPI without any documented indication.
authors.forename: Melissa
authors.initials: M
authors.lastname: Ratelle
authors.forename: Sylvie
authors.initials: S
authors.lastname: Perreault
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Villeneuve
authors.forename: Lydjie
authors.initials: L
authors.lastname: Tremblay
mesh_terms: D000368:Aged; D001201:Ascites / Q000150:complications / Q000188:drug therapy; D016022:Case-Control Studies; D005260:Female; D006090:Gram-Negative Bacteria / Q000302:isolation & purification; D016905:Gram-Negative Bacterial Infections / Q000453:epidemiology / Q000382:microbiology; D006094:Gram-Positive Bacteria / Q000302:isolation & purification; D016908:Gram-Positive Bacterial Infections / Q000453:epidemiology / Q000382:microbiology; D006785:Hospitals, University; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010538:Peritonitis / Q000453:epidemiology* / Q000382:microbiology; D054328:Proton Pump Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D011792:Quebec / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D054328:Proton Pump Inhibitors