Document Detail

Iatrogenic gastric acid suppression and the risk of nosocomial Clostridium difficile infection.
MedLine Citation:
PMID:  20458086     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: The incidence and severity of Clostridium difficile infections are increasing. Acid-suppressive therapy has been suggested as a risk factor for C difficile, but this remains controversial. METHODS: We conducted a pharmacoepidemiologic cohort study, performing a secondary analysis of data collected prospectively on 101 796 discharges from a tertiary care medical center during a 5-year period. The primary exposure of interest was acid suppression therapy, classified by the most intense acid suppression therapy received (no acid suppression, histamine(2)-receptor antagonist [H(2)RA] therapy, daily proton pump inhibitor [PPI], and PPI more frequently than daily). RESULTS: As the level of acid suppression increased, the risk of nosocomial C difficile infection increased, from 0.3% (95% confidence interval [CI], 0.21%-0.31%) in patients not receiving acid suppressive therapy to 0.6% (95% CI, 0.49%-0.79%) in those receiving H(2)RA therapy, to 0.9% (95% CI, 0.80%-0.98%) in those receiving daily PPI treatment, and to 1.4% (1.15%-1.71%) in those receiving more frequent PPI therapy. After adjustment for comorbid conditions, age, antibiotics, and propensity score-based likelihood of receipt of acid-suppression therapy, the association persisted, increasing from an odds ratio of 1 (no acid suppression [reference]) to 1.53 (95% CI, 1.12-2.10) (H(2)RA), to 1.74 (95% CI, 1.39-2.18) (daily PPI), and to 2.36 (95% CI, 1.79-3.11) (more frequent PPI). Similar estimates were found with a matched cohort analysis and with nested case-control techniques. CONCLUSIONS: Increasing levels of pharmacologic acid suppression are associated with increased risks of nosocomial C difficile infection. This evidence of a dose-response effect provides further support for the potentially causal nature of iatrogenic acid suppression in the development of nosocomial C difficile infection.
Michael D Howell; Victor Novack; Philip Grgurich; Diane Soulliard; Lena Novack; Michael Pencina; Daniel Talmor
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Archives of internal medicine     Volume:  170     ISSN:  1538-3679     ISO Abbreviation:  Arch. Intern. Med.     Publication Date:  2010 May 
Date Detail:
Created Date:  2010-05-11     Completed Date:  2010-06-02     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0372440     Medline TA:  Arch Intern Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  784-90     Citation Subset:  AIM; IM    
Silverman Institute for Healthcare Quality and Safety, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215, USA.
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MeSH Terms
Anti-Ulcer Agents / adverse effects*
Boston / epidemiology
Case-Control Studies
Clostridium Infections / chemically induced*,  epidemiology
Clostridium difficile*
Cross Infection / chemically induced*,  epidemiology
Dose-Response Relationship, Drug
Histamine H2 Antagonists / adverse effects*
Kaplan-Meiers Estimate
Matched-Pair Analysis
Multivariate Analysis
Propensity Score
Prospective Studies
Proton Pump Inhibitors / administration & dosage,  adverse effects*
Risk Factors
Reg. No./Substance:
0/Anti-Ulcer Agents; 0/Histamine H2 Antagonists; 0/Proton Pump Inhibitors

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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