PMID- 38267263
OWN - NLM
STAT- MEDLINE
DCOM- 20240304
LR  - 20240304
IS  - 1460-2091 (Electronic)
IS  - 0305-7453 (Print)
IS  - 0305-7453 (Linking)
VI  - 79
IP  - 3
DP  - 2024 Mar 1
TI  - The combined effect of systemic antibiotics and proton pump inhibitors on 
      Clostridioides difficile infection and recurrence.
PG  - 608-616
LID - 10.1093/jac/dkae012 [doi]
AB  - BACKGROUND: Antibiotics and proton pump inhibitors (PPI) are recognized risk 
      factors for acquisition and recurrence of Clostridioides difficile infection 
      (CDI), yet combined effects remain unclear. OBJECTIVES: To assess the short- and 
      long-term effects of antibiotics and PPIs on CDI risk and recurrence. METHODS: 
      Population-based study including all 43 152 patients diagnosed with CDI in Sweden 
      (2006-2019), and 355 172 matched population controls without CDI. The impact of 
      antibiotics and PPIs on CDI risk and recurrence was explored for recent (0-30 
      days) and preceding (31-180 days) use prior to their first CDI diagnosis, using 
      multivariable conditional logistic regression presented as odds ratios (ORs) and 
      95% confidence interval, adjusted for demographics, comorbidities and other 
      drugs. RESULTS: Compared to controls, the combined effect of recent PPIs and 
      antibiotics [ORAB+PPI = 17.51 (17.48-17.53)] on CDI risk was stronger than the 
      individual effects [ORAB = 15.37 (14.83-15.93); ORPPI = 2.65 (2.54-2.76)]. 
      Results were less pronounced for exposure during the preceding months. 
      Dose-response analyses showed increasing exposure correlated with CDI risk 
      [recent use: ORAB = 6.32 (6.15-6.49); ORPPI = 1.65 (1.62-1.68) per prescription 
      increase].Compared to individuals without recurrence (rCDI), recent [ORAB = 1.30 
      (1.23-1.38)] and preceding [ORAB = 1.23 (1.16-1.31); ORPPI = 1.12 (1.03-1.21)] 
      use also affected the risk of recurrence yet without significant interaction 
      between both. Recent macrolides/lincosamides/streptogramins; other antibacterials 
      including nitroimidazole derivates; non-penicillin beta lactams and quinolones 
      showed the strongest association with CDI risk and recurrence, particularly for 
      recent use. PPI use, both recent and preceding, further increased the CDI risk 
      associated with almost all antibiotic classes. CONCLUSION: Recent and less recent 
      use of PPIs and systemic antibiotics was associated with an increased risk of 
      CDI, particularly in combination.
CI  - (c) The Author(s) 2024. Published by Oxford University Press on behalf of British 
      Society for Antimicrobial Chemotherapy.
FAU - Moreels, Nele
AU  - Moreels N
AD  - Department of Microbiology, Centre for Translational Microbiome Research, Tumour 
      and Cell Biology, Karolinska Institutet, Stockholm, Sweden.
AD  - I-BioStat, Data Science Institute, Hasselt University, Hasselt, Belgium.
FAU - Boven, Annelies
AU  - Boven A
AD  - Department of Microbiology, Centre for Translational Microbiome Research, Tumour 
      and Cell Biology, Karolinska Institutet, Stockholm, Sweden.
AD  - Department of Family Medicine and Population Health, Global Health Institute, 
      Antwerp University, Antwerp, Belgium.
FAU - Gressani, Oswaldo
AU  - Gressani O
AD  - I-BioStat, Data Science Institute, Hasselt University, Hasselt, Belgium.
FAU - Andersson, Fredrik L
AU  - Andersson FL
AD  - Global Value & Access, Ferring Pharmaceuticals, Copenhagen, Denmark.
FAU - Vlieghe, Erika
AU  - Vlieghe E
AD  - Department of Family Medicine and Population Health, Global Health Institute, 
      Antwerp University, Antwerp, Belgium.
FAU - Callens, Steven
AU  - Callens S
AD  - Department of Internal Medicine and Pediatrics, General Internal Medicine, Ghent 
      University, Ghent, Belgium.
FAU - Engstrand, Lars
AU  - Engstrand L
AD  - Department of Microbiology, Centre for Translational Microbiome Research, Tumour 
      and Cell Biology, Karolinska Institutet, Stockholm, Sweden.
FAU - Simin, Johanna
AU  - Simin J
AD  - Department of Microbiology, Centre for Translational Microbiome Research, Tumour 
      and Cell Biology, Karolinska Institutet, Stockholm, Sweden.
FAU - Brusselaers, Nele
AU  - Brusselaers N
AUID- ORCID: 0000-0003-0137-447X
AD  - Department of Microbiology, Centre for Translational Microbiome Research, Tumour 
      and Cell Biology, Karolinska Institutet, Stockholm, Sweden.
AD  - Department of Family Medicine and Population Health, Global Health Institute, 
      Antwerp University, Antwerp, Belgium.
AD  - Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.
LA  - eng
GR  - Centre for Translational Microbiome Research/
GR  - Karolinska Instituted, Sweden/
GR  - Research Collaboration Agreement with Ferring Pharmaceuticals/
PT  - Journal Article
PL  - England
TA  - J Antimicrob Chemother
JT  - The Journal of antimicrobial chemotherapy
JID - 7513617
RN  - 0 (Anti-Bacterial Agents)
RN  - 0 (Proton Pump Inhibitors)
RN  - 0 (Streptogramins)
RN  - 0 (Quinolones)
SB  - IM
MH  - Humans
MH  - Anti-Bacterial Agents/adverse effects
MH  - Proton Pump Inhibitors/adverse effects
MH  - Streptogramins
MH  - *Clostridium Infections/epidemiology
MH  - *Quinolones
PMC - PMC10904719
EDAT- 2024/01/25 00:42
MHDA- 2024/03/04 06:43
PMCR- 2024/01/24
CRDT- 2024/01/24 21:53
PHST- 2023/06/26 00:00 [received]
PHST- 2024/01/03 00:00 [accepted]
PHST- 2024/03/04 06:43 [medline]
PHST- 2024/01/25 00:42 [pubmed]
PHST- 2024/01/24 21:53 [entrez]
PHST- 2024/01/24 00:00 [pmc-release]
AID - 7588672 [pii]
AID - dkae012 [pii]
AID - 10.1093/jac/dkae012 [doi]
PST - ppublish
SO  - J Antimicrob Chemother. 2024 Mar 1;79(3):608-616. doi: 10.1093/jac/dkae012.