Assessing the Risk of Hospital-Acquired Clostridium Difficile Infection With Proton Pump Inhibitor Use: A Meta-Analysis.
BACKGROUND Clostridium difficile is the principal infectious cause of antibiotic-associated diarrhea and accounts for 12% of hospital-acquired infections. Recent literature has shown an increased risk of C. difficile infection (CDI) with proton pump inhibitor (PPI) use. OBJECTIVE To conduct a systematic assessment of the risk of hospital-acquired CDI following exposure to PPI. METHODS We searched multiple databases for studies examining the relationship between PPI and hospital-acquired CDI. Pooled odds ratios were generated and assessment for heterogeneity performed. RESULTS We found 23 observational studies involving 186,033 cases that met eligibility criteria. Across studies, 10,307 cases of hospital-acquired CDI were reported. Significant heterogeneity was present; therefore, a random effects model was used. The pooled odds ratio was 1.81 (95% CI, 1.52-2.14), favoring higher risk of CDI with PPI use. Significant heterogeneity was present, likely due to differences in assessment of exposure, study population, and definition of CDI. DISCUSSION This meta-analysis suggests PPIs significantly increase the risk of hospital-acquired CDI. Given the significant health and economic burden of CDI and the risks of PPI, optimization of PPI use should be included in a multifaceted approach to CDI prevention. Infect Control Hosp Epidemiol 2016;1408-1417.
1Tulane University School of Public Health and Tropical Medicine,Department of Epidemiology,New Orleans,Louisiana.
Vanessa
V
Arriola
2Department of Medicine,University of Wisconsin School of Medicine and Public Health,Madison,Wisconsin.
Jessica
J
Tischendorf
3Institute of Clinical and Translational Research,University of Wisconsin,Madison,Wisconsin.
Jackson
J
Musuuza
4University of Wisconsin School of Medicine and Public Health,Madison,Wisconsin.
Anna
A
Barker
1Tulane University School of Public Health and Tropical Medicine,Department of Epidemiology,New Orleans,Louisiana.
Jeffrey W
JW
Rozelle
2Department of Medicine,University of Wisconsin School of Medicine and Public Health,Madison,Wisconsin.
Nasia
N
Safdar
D016360:Clostridioides difficile; D003015:Clostridium Infections / Q000453:epidemiology* / Q000209:etiology*; D003428:Cross Infection / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology*; D003967:Diarrhea; D006801:Humans; D054328:Proton Pump Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D012307:Risk Factors
D054328:Proton Pump Inhibitors
J Antimicrob Chemother. 2014 Apr;69(4):1127-31
24327619
N Engl J Med. 2014 Mar 27;370(13):1198-208
24670166
Clin Gastroenterol Hepatol. 2012 Mar;10(3):225-33
22019794
Crit Care. 2014 Dec 24;18(6):714
25540023
Mayo Clin Proc. 2012 Jul;87(7):636-42
22766083
Infect Control Hosp Epidemiol. 2005 Mar;26(3):273-80
15796280
J Hosp Med. 2012 May-Jun;7(5):421-5
22190465
Infect Control Hosp Epidemiol. 2007 Nov;28(11):1305-7
17926283
Pharmacoepidemiol Drug Saf. 2011 Oct;20(10):1035-42
21833992
QJM. 2000 Mar;93(3):175-81
10751237
PLoS Med. 2009 Jul 21;6(7):e1000097
19621072
Clin Infect Dis. 2012 Aug;55 Suppl 2:S88-92
22752870
Biomed J. 2014 Jul-Aug;37(4):178-83
25116712
Infect Control Hosp Epidemiol. 2015 Apr;36(4):452-60
25626326
Am J Gastroenterol. 2008 Sep;103(9):2308-13
18702653
Infect Control Hosp Epidemiol. 2005 Aug;26(8):685-90
16156324
Biometrics. 2000 Jun;56(2):455-63
10877304
Am J Gastroenterol. 2015 Mar;110(3):381-90; quiz 391
25732416
Clin Infect Dis. 2007 Nov 1;45(9):1141-51
17918075
N Engl J Med. 2005 Dec 8;353(23):2442-9
16322602
J Am Med Dir Assoc. 2005 Mar-Apr;6(2):105-8
15871884
Lancet. 2005 Sep 24-30;366(9491):1079-84
16182895
J Crit Care. 2010 Jun;25(2):214-20
19683892
J Hosp Infect. 2008 Dec;70(4):298-304
18951661
Aliment Pharmacol Ther. 2009 Mar 15;29(6):626-34
19183143
J Pharm Pract. 2013 Oct;26(5):464-75
24064435
Infect Control Hosp Epidemiol. 2001 Sep;22(9):572-5
11732787
Gastroenterol Res Pract. 2015;2015:689531
25733976
Trends Microbiol. 2014 Jul;22(7):406-16
24814671
World J Gastroenterol. 2010 Jul 28;16(28):3573-7
20653067
Am J Gastroenterol. 2012 Jul;107(7):1011-9
22525304
JAMA. 2000 Apr 19;283(15):2008-12
10789670
PLoS One. 2014 Oct 24;9(10):e110790
25343667
J Clin Epidemiol. 2001 Oct;54(10):1046-55
11576817
PLoS One. 2014 Nov 05;9(11):e111735
25372033
Clin Infect Dis. 2013 Jun;56(11):1589-600
23463640
J Bone Joint Surg Br. 2010 Jul;92(7):994-8
20595121
Can J Hosp Pharm. 2010 Jan;63(1):31-7
22478951
Clin Infect Dis. 2007 Dec 15;45(12):1543-9
18190314
Ann Pharmacother. 2014 Apr;48(4):462-9
24473490
Infect Control Hosp Epidemiol. 2008 Jan;29(1):44-50
18171186
PLoS One. 2012;7(12):e50836
23236397
Arch Intern Med. 2010 May 10;170(9):784-90
20458086
Aliment Pharmacol Ther. 2016 May;43(9):974-84
26923470
Arch Intern Med. 2006 Dec 11-25;166(22):2518-24
17159019
N Engl J Med. 1994 Jan 27;330(4):257-62
8043060
Am J Med. 2015 Aug;128(8):905-13
25820164
J Infect Dis. 2010 Dec 15;202(12):1877-84
21050115
Microbiome. 2014 Nov 25;2:42
25426290