PMID- 21833992
OWN - NLM
STAT- MEDLINE
DCOM- 20120213
LR  - 20220330
IS  - 1099-1557 (Electronic)
IS  - 1053-8569 (Linking)
VI  - 20
IP  - 10
DP  - 2011 Oct
TI  - Differential risk of Clostridium difficile infection with proton pump inhibitor 
      use by level of antibiotic exposure.
PG  - 1035-42
LID - 10.1002/pds.2198 [doi]
AB  - PURPOSE: Clostridium difficile infection (CDI) is a major cause of 
      hospital-acquired diarrhea worldwide. We examined the risk of CDI associated with 
      the use of acid-suppressive agents (proton pump inhibitors [PPI] and histamine-2 
      receptor blockers) and determined whether this risk varied by number or type of 
      antibiotic (high or low CDI risk) received during hospitalization. METHODS: We 
      conducted a retrospective cohort study of hospitalizations among adult patients 
      at an academic teaching hospital in Rochester, New York, during which two or more 
      days of antibiotics were prescribed. Multivariable marginal Cox proportional 
      hazards models with time-varying exposures were used to examine time to the 
      development of CDI. RESULTS: A total of 10 154 hospitalizations and 241 cases of 
      CDI, defined as detection of C. difficile toxin in a diarrheal stool sample 
      within 60 days of discharge, were identified. PPI use was independently 
      associated with an increased risk of CDI (adjusted hazard ratio = 4.5; 95% 
      confidence interval [CI] = 2.3-9.0). Among hospitalizations during which one, 
      two, three or four, and five or more antibiotics were prescribed, the adjusted 
      hazard ratios for PPI use were 15.7 (CI = 6.4-38.8), 4.9 (CI = 2.2-11.2), 4.3 
      (CI = 1.9-9.9), and 2.7 (CI = 1.2-5.9), respectively (p for interaction = .002). 
      CONCLUSIONS: The use of PPI is common among patients receiving antibiotics during 
      hospitalization. The greater risk of CDI in relation to PPI among 
      hospitalizations during which fewer or low-risk antibiotics were prescribed 
      suggests a potentially clinically relevant interaction between antibiotics and 
      PPI. Further study is needed to elucidate possible mechanisms for the observed 
      effect.
CI  - Copyright (c) 2011 John Wiley & Sons, Ltd.
FAU - Stevens, Vanessa
AU  - Stevens V
AD  - Center for Health Outcomes, Pharmacoinformatics, and Epidemiology, SUNY Buffalo 
      School of Pharmacy and Pharmaceutical Sciences, Buffalo, NY, USA. 
      vstevens@buffalo.edu
FAU - Dumyati, Ghinwa
AU  - Dumyati G
FAU - Brown, Jack
AU  - Brown J
FAU - Wijngaarden, Edwin
AU  - Wijngaarden E
LA  - eng
PT  - Journal Article
DEP - 20110810
PL  - England
TA  - Pharmacoepidemiol Drug Saf
JT  - Pharmacoepidemiology and drug safety
JID - 9208369
RN  - 0 (Anti-Bacterial Agents)
RN  - 0 (Histamine H2 Antagonists)
RN  - 0 (Proton Pump Inhibitors)
SB  - IM
MH  - Adult
MH  - Anti-Bacterial Agents/adverse effects/metabolism/*therapeutic use
MH  - Clostridioides difficile/drug effects/physiology
MH  - Clostridium Infections/drug therapy/*epidemiology/metabolism
MH  - Cohort Studies
MH  - Drug Interactions
MH  - Histamine H2 Antagonists/*adverse effects/pharmacology/therapeutic use
MH  - Hospitalization
MH  - Humans
MH  - Proton Pump Inhibitors/*adverse effects/pharmacology/therapeutic use
MH  - Retrospective Studies
MH  - Risk
MH  - Treatment Outcome
EDAT- 2011/08/13 06:00
MHDA- 2012/02/14 06:00
CRDT- 2011/08/12 06:00
PHST- 2011/03/01 00:00 [received]
PHST- 2011/06/01 00:00 [revised]
PHST- 2011/06/09 00:00 [accepted]
PHST- 2011/08/12 06:00 [entrez]
PHST- 2011/08/13 06:00 [pubmed]
PHST- 2012/02/14 06:00 [medline]
AID - 10.1002/pds.2198 [doi]
PST - ppublish
SO  - Pharmacoepidemiol Drug Saf. 2011 Oct;20(10):1035-42. doi: 10.1002/pds.2198. Epub 
      2011 Aug 10.