title: Risk of Clostridium difficile Infection with the Use of a Proton Pump Inhibitor for Stress Ulcer Prophylaxis in Critically Ill Patients.
abstract: OBJECTIVE
  Proton pump inhibitors (PPIs) and histamine-2 receptor antagonists (H2RAs) are commonly prescribed for stress ulcer prophylaxis (SUP) in critically ill patients. Several studies have suggested that the use of PPIs is a potential risk factor for Clostridium difficile infection (CDI). We compared the incidences of CDI in the PPI group and H2RA group for SUP in critically ill patients.
  
  
  METHODS
  From August 2005 to July 2012, the incidences of CDI were retrospectively analyzed in patients who were admitted directly to intensive care units and stayed for more than 3 days. SUP-related CDI was defined as a CDI diagnosed during the SUP period. Patient clinical data were analyzed to identify potential risk factors for SUP-related CDI.
  
  
  RESULTS
  Of the 1,005 patients enrolled (444 patients received PPI and 561 received H2RA), 38 (3.8%) were diagnosed with SUP-related CDI. The incidence of SUP-related CDI was considerably higher in patients who received PPI than in those who received H2RA (6.7% vs 1.8%). PPI use for SUP (odds ratio [OR], 3.3; confidence interval [CI], 1.5 to 7.1; p=0.003) and diabetes mellitus (OR, 2.3; CI, 1.2 to 4.7; p=0.019) were independent risk factors for SUP-related CDI.
  
  
  CONCLUSIONS
  PPI therapy is associated with a higher risk of SUP-related CDI than H2RA therapy in critically ill patients.
authors.affiliation: Department of Internal Medicine, Hanyang University Guri Hospital, Guri, Korea.
authors.forename: Youngouk
authors.initials: Y
authors.lastname: Ro
authors.affiliation: Department of Internal Medicine, Hanyang University Guri Hospital, Guri, Korea.
authors.forename: Chang Soo
authors.initials: CS
authors.lastname: Eun
authors.affiliation: Department of Internal Medicine, Hanyang University Guri Hospital, Guri, Korea.
authors.forename: Hyun Soo
authors.initials: HS
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Hanyang University Guri Hospital, Guri, Korea.
authors.forename: Ji Yeoun
authors.initials: JY
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Hanyang University Guri Hospital, Guri, Korea.
authors.forename: Young Jae
authors.initials: YJ
authors.lastname: Byun
authors.affiliation: Department of Internal Medicine, Hanyang University Guri Hospital, Guri, Korea.
authors.forename: Kyo-Sang
authors.initials: KS
authors.lastname: Yoo
authors.affiliation: Department of Internal Medicine, Hanyang University Guri Hospital, Guri, Korea.
authors.forename: Dong Soo
authors.initials: DS
authors.lastname: Han
mesh_terms: D000368:Aged; D016360:Clostridioides difficile / Q000187:drug effects; D003015:Clostridium Infections / Q000139:chemically induced* / Q000453:epidemiology; D016638:Critical Illness / Q000628:therapy*; D003428:Cross Infection / Q000139:chemically induced* / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D003668:Pressure Ulcer / Q000517:prevention & control*; D054328:Proton Pump Inhibitors / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D054328:Proton Pump Inhibitors
keywords: Clostridium difficile; Critical care; Histamine-2 receptor antagonist; Proton pump inhibitor