TY - JOUR
T1 - Effects of proton pump inhibitor use on risk of Clostridium difficile infection
T2 - a hospital cohort study
AU - Park, Yoon Hee
AU - Seong, Jong Mi
AU - Cho, Soyeon
AU - Han, Hye Won
AU - Kim, Jae Youn
AU - An, Sook Hee
AU - Gwak, Hye Sun
N1 - Publisher Copyright:
© 2019, Japanese Society of Gastroenterology.
PY - 2019/12/1
Y1 - 2019/12/1
N2 - Background: Although there are several studies on the association between use of proton pump inhibitors (PPIs) and increased Clostridium difficile infection (CDI) risk, detailed studies analyzing the effects of PPI use on CDI risk are lacking. The present study investigated the association of the dose, duration, and types of PPIs with CDI risk. Methods: A single-center, cohort study was conducted on patients admitted to a hospital. The exposed cohort comprised patients who were prescribed PPIs at least once during the study period, and a control cohort was prepared by randomly assigning an index date to patients who did not use PPIs ensuring the same distribution of index dates as in the exposed cohort and matching sex, age, hospitalization period, and date of admission. Results: PPI use increased the risk of CDI by 1.8-fold [95% confidence interval (CI) 1.5–2.2]. CDI risk increased by 1.8-fold with esomeprazole (95% CI 1.4–2.2) and 2.0-fold with pantoprazole (95% CI 1.5–2.8). Patients who used a high dose had a higher risk than those who used a medium dose [adjusted hazard ratio (HR) 2.0 vs 1.3]. The risk of CDI increased 4.2-fold when the PPI exposure period was 6 days or shorter than 6 days. Conclusions: Our study showed that PPI use was associated with an increased risk of developing CDI and the risk of CDI was dose dependent. Therefore, PPIs should only be used at proper doses and only for the necessary indications to avoid CDI risk.
AB - Background: Although there are several studies on the association between use of proton pump inhibitors (PPIs) and increased Clostridium difficile infection (CDI) risk, detailed studies analyzing the effects of PPI use on CDI risk are lacking. The present study investigated the association of the dose, duration, and types of PPIs with CDI risk. Methods: A single-center, cohort study was conducted on patients admitted to a hospital. The exposed cohort comprised patients who were prescribed PPIs at least once during the study period, and a control cohort was prepared by randomly assigning an index date to patients who did not use PPIs ensuring the same distribution of index dates as in the exposed cohort and matching sex, age, hospitalization period, and date of admission. Results: PPI use increased the risk of CDI by 1.8-fold [95% confidence interval (CI) 1.5–2.2]. CDI risk increased by 1.8-fold with esomeprazole (95% CI 1.4–2.2) and 2.0-fold with pantoprazole (95% CI 1.5–2.8). Patients who used a high dose had a higher risk than those who used a medium dose [adjusted hazard ratio (HR) 2.0 vs 1.3]. The risk of CDI increased 4.2-fold when the PPI exposure period was 6 days or shorter than 6 days. Conclusions: Our study showed that PPI use was associated with an increased risk of developing CDI and the risk of CDI was dose dependent. Therefore, PPIs should only be used at proper doses and only for the necessary indications to avoid CDI risk.
KW - Clostridium difficile
KW - Diarrhea
KW - Proton pump inhibitor
UR - http://www.scopus.com/inward/record.url?scp=85067273130&partnerID=8YFLogxK
U2 - 10.1007/s00535-019-01598-2
DO - 10.1007/s00535-019-01598-2
M3 - Article
C2 - 31187275
AN - SCOPUS:85067273130
SN - 0944-1174
VL - 54
SP - 1052
EP - 1060
JO - Journal of Gastroenterology
JF - Journal of Gastroenterology
IS - 12
ER -