JAMA internal medicine
TAKE-HOME MESSAGE
- Researchers retrospectively evaluated 754 patients with healthcare-associated Clostridium difficile infection to determine the association of proton pump inhibitor use (PPI) with recurrence.
- The hazard ratio for recurrence was 1.5 for continuous PPI use, and 47.1% of patients receiving PPIs had an evidence-based indication.
- Researchers suggest that PPI use without proper indication should be discontinued in patients with a C. difficile diagnosis.
Abstract
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STORY OF THE WEEK
Published in Primary Care and 1 other channel
Journal Scan / Research · March 16, 2015
Proton Pump Inhibitor Use Increases Risk for Recurrent C. difficile
JAMA internal medicine
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TAKE-HOME MESSAGE
Researchers retrospectively evaluated 754 patients with healthcare-associated Clostridium difficile infection to determine the association of proton pump inhibitor use (PPI) with recurrence. The hazard ratio for recurrence was 1.5 for continuous PPI use, and 47.1% of patients receiving PPIs had an evidence-based indication.
Researchers suggest that PPI use without proper indication should be discontinued in patients with a C. difficile diagnosis.
Abstract
This abstract is available on the publisher’s site.
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IMPORTANCE
Clostridium difficile infection (CDI) is associated with significant morbidity, mortality, and a high risk of recurrence. Proton pump inhibitor (PPI) use is associated with an initial episode of CDI, and PPIs are frequently overprescribed. For many, the use of PPIs could likely be discontinued before CDI recurrence.
OBJECTIVES
To determine whether PPI use was associated with a risk of initial CDI recurrence, to assess what proportion of patients who developed CDI were taking a PPI for a non–evidence-based indication, and to evaluate whether physicians discontinued unnecessary PPIs in the context of CDI.
DESIGN, SETTING, AND PARTICIPANTS
We conducted a retrospective cohort study of incident health care–associated CDI cases to determine the association between continuous PPI use and CDI recurrence within 90 days. The setting was 2 university-affiliated hospitals, the 417-bed Montreal General Hospital (Montreal, Quebec, Canada) and the 517-bed Royal Victoria Hospital (Montreal, Quebec, Canada). The cohort consisted of 754 patients who developed health care–associated CDI between January 1, 2010, and January 30, 2013, and who survived for a minimum of 15 days after their initial episode of nosocomial CDI.
EXPOSURE
Continuous PPI use.
MAIN OUTCOMES AND MEASURES
Recurrence of CDI within 15 to 90 days of the initial episode.
RESULTS
Using a multivariable Cox proportional hazards model, the cause-specific hazard ratios for recurrence were 1.5 (95% CI, 1.1-2.0) for age older than 75 years, 1.5 (95% CI, 1.1-2.0) for continuous PPI use, 1.003 (95% CI, 1.002-1.004) per day for length of stay, and 1.3 (95% CI, 0.9-1.7) for antibiotic reexposure. The use of PPIs was common (60.7%), with only 47.1% of patients having an evidence-based indication. Proton pump inhibitors were discontinued in only 3 patients with CDI.
CONCLUSIONS AND RELEVANCE
After adjustment for other independent predictors of recurrence, patients with continuous PPI use remained at elevated risk of CDI recurrence. We suggest that the cessation of unnecessary PPI use should be considered at the time of CDI diagnosis.