PMID- 31210787
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220408
IS  - 1757-4749 (Print)
IS  - 1757-4749 (Electronic)
IS  - 1757-4749 (Linking)
VI  - 11
DP  - 2019
TI  - Proton pump inhibitors and 180-day mortality in the elderly after Clostridium 
      difficile treatment.
PG  - 29
LID - 10.1186/s13099-019-0309-6 [doi]
LID - 29
AB  - BACKGROUND: There is a reported association between proton pump inhibitor (PPI) 
      exposure and increased risk of Clostridium difficile infection (CDI), but less is 
      known about how this class of medications taken during treatment might influence 
      mortality after CDI. Here we examine 180-day mortality rates in a cohort of CDI 
      elders and its association with exposure to PPIs. We conducted a retrospective 
      cohort study of elderly patients (> 65 years of age) diagnosed and treated for 
      CDI in the years 2014-2016 (n = 874) in the Umass Memorial Health Care system, 
      which represents both academic and community healthcare. Patient characteristics 
      and medication use was extracted from the electronic medical record (EMR) and 
      6 month mortality data was obtained via the Center for Disease Control National 
      Death Index. A Cox proportional hazards model was used to estimate hazard ratios 
      associated with medication exposures and other relevant variables. RESULTS: Of 
      the 874 elderly adults treated for CDI, 180-day all-cause mortality was 12.4%. 
      Exposure to a PPI was associated with a 55% reduced risk of mortality (adjusted 
      hazard ratio (aHR) 0.45; 95% confidence interval (CI) 0.28-0.72). In our Cox 
      model, increasing age (aHR 1.45; 95% CI 1.14-1.84), those with severe CDI 
      infections (aHR 1.87; 95% CI 1.22-2.88), and those with hospital acquired CDI 
      (aHR 3.01; 95% CI 1.81-4.99) also had increased 180 day mortality risk. There 
      were similar associations noted with both 90 day and 1-year mortality. 
      CONCLUSION: Use of PPIs during CDI treatment in elderly patients is associated 
      with decreased 180-day mortality. Although use of PPIs has been associated with 
      an increased risk of CDI, it appears to be protective against mortality when used 
      during the treatment phase.
FAU - Bradley, Evan Stuart
AU  - Bradley ES
AUID- ORCID: 0000-0001-7704-6371
AD  - Department of Emergency Medicine, University of Massachusetts Medical School and 
      Umass Memorial Medical Center, 55 North Lake Avenue, Worcester, MA 01605 USA.
FAU - Howe, Emily
AU  - Howe E
AD  - 2University of Massachusetts Medical School, 55 North Lake Avenue, Worcester, MA 
      01605 USA. ISNI: 0000 0001 0742 0364. GRID: grid.168645.8
FAU - Wu, Xun
AU  - Wu X
AD  - 2University of Massachusetts Medical School, 55 North Lake Avenue, Worcester, MA 
      01605 USA. ISNI: 0000 0001 0742 0364. GRID: grid.168645.8
FAU - Haran, John P
AU  - Haran JP
AD  - Department of Emergency Medicine, University of Massachusetts Medical School and 
      Umass Memorial Medical Center, 55 North Lake Avenue, Worcester, MA 01605 USA.
LA  - eng
PT  - Journal Article
DEP - 20190613
PL  - England
TA  - Gut Pathog
JT  - Gut pathogens
JID - 101474263
PMC - PMC6563367
OTO - NOTNLM
OT  - Clostridium difficile
OT  - Enteric pathogens
OT  - Infectious disease
OT  - Medication safety
OT  - Proton pump inhibitors
COIS- Competing interestsThe authors declare that they have no competing interests.
EDAT- 2019/06/19 06:00
MHDA- 2019/06/19 06:01
PMCR- 2019/06/13
CRDT- 2019/06/19 06:00
PHST- 2019/03/31 00:00 [received]
PHST- 2019/05/29 00:00 [accepted]
PHST- 2019/06/19 06:00 [entrez]
PHST- 2019/06/19 06:00 [pubmed]
PHST- 2019/06/19 06:01 [medline]
PHST- 2019/06/13 00:00 [pmc-release]
AID - 309 [pii]
AID - 10.1186/s13099-019-0309-6 [doi]
PST - epublish
SO  - Gut Pathog. 2019 Jun 13;11:29. doi: 10.1186/s13099-019-0309-6. eCollection 2019.