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Effects of proton pump inhibitor use on risk of Clostridium difficile infection: a hospital cohort study

  • Original Article—Alimentary Tract
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Abstract

Background

Although there are several studies on the association between use of proton pump inhibitors (PPIs) and increased Clostridium difficile infection (CDI) risk, detailed studies analyzing the effects of PPI use on CDI risk are lacking. The present study investigated the association of the dose, duration, and types of PPIs with CDI risk.

Methods

A single-center, cohort study was conducted on patients admitted to a hospital. The exposed cohort comprised patients who were prescribed PPIs at least once during the study period, and a control cohort was prepared by randomly assigning an index date to patients who did not use PPIs ensuring the same distribution of index dates as in the exposed cohort and matching sex, age, hospitalization period, and date of admission.

Results

PPI use increased the risk of CDI by 1.8-fold [95% confidence interval (CI) 1.5–2.2]. CDI risk increased by 1.8-fold with esomeprazole (95% CI 1.4–2.2) and 2.0-fold with pantoprazole (95% CI 1.5–2.8). Patients who used a high dose had a higher risk than those who used a medium dose [adjusted hazard ratio (HR) 2.0 vs 1.3]. The risk of CDI increased 4.2-fold when the PPI exposure period was 6 days or shorter than 6 days.

Conclusions

Our study showed that PPI use was associated with an increased risk of developing CDI and the risk of CDI was dose dependent. Therefore, PPIs should only be used at proper doses and only for the necessary indications to avoid CDI risk.

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Author notes

  1. Yoon Hee Park and Jong Mi Seong equally contributed to this work.

Authors and Affiliations

  1. Division of Life and Pharmaceutical Sciences, College of Pharmacy, Ewha Womans University, 52 Ewhayeodae-gil, Seodaemun-gu, Seoul, 03760, Republic of Korea

    Yoon Hee Park, Jong Mi Seong, Soyeon Cho, Hye Won Han & Hye Sun Gwak

  2. Department of Pharmacy, Asan Medical Center, 388-1 Pungnap-dong, Songpa-gu, Seoul, 05535, Republic of Korea

    Yoon Hee Park, Soyeon Cho, Hye Won Han & Jae Youn Kim

  3. College of Pharmacy, Wonkwang University, 460 Iksan-daero, Iksan, Jeonbuk, 54538, Republic of Korea

    Sook Hee An

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  1. Yoon Hee Park
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Correspondence to Hye Sun Gwak.

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Park, Y.H., Seong, J.M., Cho, S. et al. Effects of proton pump inhibitor use on risk of Clostridium difficile infection: a hospital cohort study. J Gastroenterol 54, 1052–1060 (2019). https://doi.org/10.1007/s00535-019-01598-2

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  • DOI: https://doi.org/10.1007/s00535-019-01598-2

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