The use of proton pump inhibitors (PPIs) was associated with an increase in both the rate and severity of hospital-acquired Clostridium difficile infection (CDI), according to a study published in Pharmacotherapy

Study authors performed a retrospective, single-center, cohort study to compare the rates and severity of hospital-acquired CDI among patients taking PPIs vs. those not taking PPIs. Between January 2013 and May 2014, a total of 41,663 patients with CDI were hospitalized, of which 17,471 (41.9%) received at least 1 dose of a PPI and 24,192 had no PPI exposure.  

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Hospital-acquired CDI was defined as a CDI diagnosis on or after the 3rd calendar day of admission. The data indicated 348 patients had CDI during the study period. After excluding the 269 cases presented on admission, 65 of the 17,302 (0.38%) patients eventually developed CDI in the hospital in the PPI group vs. 14 of 26,092 (0.058%) patients in the control group. Of these patients, severe CDI was found in 36 of the PPI group vs. 8 in the control group.

The unadjusted relative risk (RR) of developing hospital-acquired CDI was 6.46 (95% CI: 3.63–11.51; P<0.0001) and the unadjusted RR of developing severe CDI while taking a PPI was 6.27 (95% CI: 2.91–13.48; P<0.0001). Only 22 cases in the PPI group vs. 2 cases in the control group developed severe-complicated CDI, demonstrating an unadjusted RR of 15.3 (95% CI: 3.6–65.13; P=0.0002) of developing severe-complicated CDI. The researchers noted that confounding variables were similar between groups.

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