PPIs linked to inpatient C difficile infections

Takeaway

• Hospitalised patients receiving proton pump inhibitors (PPIs) are at greater, dose-dependent risk for Clostridium difficile infection (CDI), particularly if their exposure at admission is ≤6 days.

Why this matters

• PPIs should only be used at proper doses, and only for the necessary indications to avoid CDI risk, say researchers.

Study design

• Researchers studied CDI occurrence in hospitalised patients (N=157,693; men, 58.8%; mean age, 59.5±13.5 years; mean hospitalisation, 9.0±6.7 days), comparing outcomes for patients receiving PPIs with those of unexposed patients matched by sex, age, hospitalisation duration, and admission date.
• Funding: None disclosed.

Key results

• Overall, CDI incidence in the PPI group was 1.81 times greater than in the control group (95% CI, 1.51-2.28).
• PPIs associated with the greatest CDI risk were esomeprazole (aHR, 1.79; 95% CI, 1.44-2.21) and pantoprazole (aHR, 2.02; 95% CI, 1.47-2.76).
• High PPI doses were associated with greater CDI risk than medium doses (aHR, 1.95 vs 1.28).
• CDI incidence was 4.24 times greater when PPI exposure was ≤6 days.

Limitations

• The study was retrospective, single centre, and did not distinguish whether PPI exposure was associated with incident or recurrent CDI.