PMID- 17709687
OWN - NLM
STAT- MEDLINE
DCOM- 20071018
LR  - 20220331
IS  - 0091-7370 (Print)
IS  - 0091-7370 (Linking)
VI  - 37
IP  - 3
DP  - 2007 Summer
TI  - Clostridium difficile infection in an urban medical center: five-year analysis of 
      infection rates among adult admissions and association with the use of proton 
      pump inhibitors.
PG  - 241-7
AB  - C. difficile-associated diarrhea (CDAD) has become a major cause of morbidity in 
      hospitalized patients. In this study of five-year (2001-2005, inclusive) trends 
      of incidence of CDAD among adults in an inner-city medical center, the overall 
      annual incidence increased from 5.08 to 8.42 cases/10(3) admissions (p = 0.0005). 
      Age distribution remained fairly constant for 2001-2004 but decreased 
      significantly in 2005 (p = 0.005); no significant change was observed for gender. 
      During the five-year period, we observed a decline in the use of histamine type 2 
      receptor antagonists (H2A) with a concomitant increase in the use of proton pump 
      inhibitors (PPI) as a prophylactic measure to prevent stress ulcers. The usage of 
      PPI correlated exactly (r(s) = 1.0; p = 0.017) with the increase in CDAD 
      incidence. A case (n = 122)-control (n = 244) study for the final year was 
      conducted, examining the association of PPI and H2A with CDAD. After controlling 
      for the effect of antibiotic use, PPI either pre- or during admission was 
      associated with CDAD (odds ratio, OR (adjusted) = 2.75, 95% CI = 1.68 to 4.52; p 
      = 0.0001); the association with H2A was not significant (OR (adjusted) = 0.95, 
      95% CI = 0.39 to 2.34; p = 0.9153). If only first-time use during hospital stay 
      is considered, PPI were also strongly associated with CDAD (OR (adjusted) = 1.88, 
      95% CI: 1.07 to 3.31; p = 0.0283) and H2A were not associated with CDAD (OR 
      (adjusted) = 0.73, 95%CI: 0.26 to 2.06; p = 0.5520). These data suggest that the 
      widespread prescription of PPI for stress ulcer prophylaxis in acute care 
      facilities may contribute to the increased incidence of CDAD.
FAU - Jayatilaka, Suresh
AU  - Jayatilaka S
AD  - Division of Gastroenterology, School of Graduate Medical Education, Seton Hall 
      University, South Orange, NY, USA.
FAU - Shakov, Rada
AU  - Shakov R
FAU - Eddi, Rodney
AU  - Eddi R
FAU - Bakaj, Gentiana
AU  - Bakaj G
FAU - Baddoura, Walid J
AU  - Baddoura WJ
FAU - DeBari, Vincent A
AU  - DeBari VA
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Ann Clin Lab Sci
JT  - Annals of clinical and laboratory science
JID - 0410247
RN  - 0 (Anti-Ulcer Agents)
RN  - 0 (Histamine H2 Antagonists)
RN  - 0 (Proton Pump Inhibitors)
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - Anti-Ulcer Agents/*therapeutic use
MH  - Case-Control Studies
MH  - Clostridioides difficile/*isolation & purification
MH  - Diarrhea/*epidemiology/microbiology
MH  - Enterocolitis, Pseudomembranous/*epidemiology/microbiology
MH  - Female
MH  - Histamine H2 Antagonists/therapeutic use
MH  - Hospitals, Teaching
MH  - Hospitals, Urban/*statistics & numerical data
MH  - Humans
MH  - Incidence
MH  - Length of Stay
MH  - Male
MH  - Middle Aged
MH  - New Jersey/epidemiology
MH  - Odds Ratio
MH  - Peptic Ulcer/etiology/prevention & control
MH  - Postoperative Complications
MH  - *Proton Pump Inhibitors
MH  - Stress, Psychological/complications
EDAT- 2007/08/22 09:00
MHDA- 2007/10/19 09:00
CRDT- 2007/08/22 09:00
PHST- 2007/08/22 09:00 [pubmed]
PHST- 2007/10/19 09:00 [medline]
PHST- 2007/08/22 09:00 [entrez]
AID - 37/3/241 [pii]
PST - ppublish
SO  - Ann Clin Lab Sci. 2007 Summer;37(3):241-7.