title: Exposure to Gastric Acid-Suppression Therapy Is Associated With Health Care- and Community-Associated Clostridium difficile Infection in Children.
abstract: OBJECTIVE
  The aim of the study was to determine whether gastric acid-suppression therapy is associated with Clostridium difficile infection (CDI) in both inpatient and outpatient pediatric populations.
  
  
  METHODS
  We conducted a retrospective case-control study at a 200-bed academic pediatric hospital and associated outpatient clinics during 2005-2010. We defined cases as children 1 to 18 years of age with a first positive test for C difficile toxin A/B, and matched each case to 2 controls without C difficile. We conducted chart review to elicit selected comorbidities and exposure to gastric acid-suppression therapy and antibiotics in the preceding 3 months of the infection or encounter date. We used bivariate and multivariable logistic regression to evaluate the association between antacid use and CDI, controlling for potential confounders.
  
  
  RESULTS
  We identified 138 children with health care- or community-associated CDIs and 276 controls. The use of any acid suppression therapy was more common in cases compared with controls (34% vs 20%, P = 0.002). When adjusted for demographic variables and comorbidities, gastric acid-suppression therapy remained significantly associated with CDI (adjusted odds ratio [aOR] 1.8, 95% confidence interval [CI] 1.0-3.1). Antibiotic use (aOR 1.7, 95% CI 1.1-2.7) and immunosuppressed state were also associated with CDI in our adjusted model (aOR 2.5, 95% CI 1.2-5.2).
  
  
  CONCLUSIONS
  Gastric acid-suppression therapy was associated with both health care- and community-associated CDIs in children. Larger pediatric studies are necessary to determine the role of proton pump inhibitors specifically in causing CDI in children.
authors: *Division of Pediatric Gastroenterology, K. Hovnanian Children's Hospital, Jersey Shore University Medical Center, Neptune, NJ †Department of Medicine ‡Department of Pediatric, Christiana Care Health System, Newark, DE §Division of Pediatric Gastroenterology, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE.
authors: Jennifer
authors: J
authors: Jimenez
authors: Marci
authors: M
authors: Drees
authors: Beth
authors: B
authors: Loveridge-Lenza
authors: Stephen
authors: S
authors: Eppes
authors: Fernando
authors: F
authors: delRosario
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000863:Antacids / Q000009:adverse effects*; D000900:Anti-Bacterial Agents / Q000009:adverse effects; D044383:Black People; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D016360:Clostridioides difficile / Q000302:isolation & purification; D004761:Enterocolitis, Pseudomembranous / Q000139:chemically induced / Q000453:epidemiology*; D005744:Gastric Acid; D006801:Humans; D007223:Infant; D007297:Inpatients; D016017:Odds Ratio; D010045:Outpatients; D054328:Proton Pump Inhibitors / Q000009:adverse effects; D012189:Retrospective Studies; D012307:Risk Factors; D062606:Tertiary Care Centers; D014481:United States / Q000453:epidemiology; D044465:White People; D001741:Black or African American
chemical_list: D000863:Antacids; D000900:Anti-Bacterial Agents; D054328:Proton Pump Inhibitors