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Cited by 216Clostridium difficile and Clostridium perfringens researchPharmaceutical Practices and Patient OutcomesAntibiotic Use and Resistance

Continuous Proton Pump Inhibitor Therapy and the Associated Risk of Recurrent Clostridium difficile Infection

McDonald, Emily G., Milligan, Jonathon, Frenette, Charles, Lee, Todd C.·2015·JAMA Internal Medicine
DOI 10.1001/jamainternmed.2015.42
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Abstract

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.

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Authors
McDonald, E. G., Milligan, J., Frenette, C., & Lee, T. C.
Affiliations
  • McGill University Health Centre (CA)
  • University of Toronto (CA)
ORCID
Venue
JAMA Internal Medicine
Publisher
American Medical Association (AMA)
Published
2015-05-01
Volume
175
Issue
5
Pages
784
ISSN
2168-6106 (ISSN-L)
DOI
10.1001/jamainternmed.2015.42
OpenAlex
W2055606614
Cited by
216
References
32
Citations by year
2026: 11 · 2025: 11 · 2024: 17 · 2023: 13 · 2022: 11 · 2021: 22 · 2020: 19 · 2019: 20 · 2018: 20 · 2017: 33 · 2016: 25 · 2015: 14
FWCI
23.83
Type
journal article
Language
en
Open access
closed
Locations
  • JAMA Internal Medicine (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Infectious Diseases › Clostridium difficile and Clostridium perfringens research
  • Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
  • Life Sciences › Immunology and Microbiology › Applied Microbiology and Biotechnology › Antibiotic Use and Resistance
Keywords
Clostridium difficile infection, proton pump inhibitors, CDI recurrence, nosocomial infections, inappropriate prescribing, PPI discontinuation, older adults, length of hospital stay, recurrence risk factors, hospital infection control, evidence-based prescribing, antibiotic stewardship, probiotics, prebiotics
MeSH terms
Age Factors, Aged, Anti-Bacterial Agents, Canada, Clostridium Infections, Cross Infection, Female, Humans, Length of Stay, Male, Middle Aged, Retrospective Studies, Risk Factors, Incidence, Clostridioides difficile, Withholding Treatment, Proton Pump Inhibitors, Secondary Prevention, Inappropriate Prescribing

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