Assessing the Risk of Hospital-Acquired Clostridium Difficile Infection With Proton Pump Inhibitor Use: A Meta-Analysis

被引:59
作者
Arriola, Vanessa [1 ]
Tischendorf, Jessica [2 ]
Musuuza, Jackson [3 ]
Barker, Anna [4 ]
Rozelle, Jeffrey W. [1 ]
Safdar, Nasia [2 ,5 ,6 ]
机构
[1] Tulane Univ, Sch Publ Hlth & Trop Med, Dept Epidemiol, New Orleans, LA USA
[2] Univ Wisconsin, Dept Med, Sch Med & Publ Hlth, Madison, WI USA
[3] Univ Wisconsin, Inst Clin & Translat Res, Madison, WI USA
[4] Univ Wisconsin, Sch Med & Publ Hlth, Madison, WI USA
[5] Univ Wisconsin Hosp & Clin, Dept Infect Dis, Madison, WI 53792 USA
[6] William S Middleton Mem Vet Affairs Hosp, Madison, WI USA
基金
美国国家卫生研究院;
关键词
GASTRIC-ACID SUPPRESSION; STRESS-ULCER PROPHYLAXIS; DISEASE; OUTBREAK; DIARRHEA; STRAIN; ANTIBIOTICS; ENDEMICITY; INCREASE;
D O I
10.1017/ice.2016.194
中图分类号
R1 [预防医学、卫生学];
学科分类号
1004 ; 120402 ;
摘要
BACKGROUND Clostridium difficile is the principal infectious cause of antibiotic-associated diarrhea and accounts for 12% of hospital-acquired infections. Recent literature has shown an increased risk of C. difficile infection (CDI) with proton pump inhibitor (PPI) use. OBJECTIVE To conduct a systematic assessment of the risk of hospital-acquired CDI following exposure to PPI. METHODS We searched multiple databases for studies examining the relationship between PPI and hospital-acquired CDI. Pooled odds ratios were generated and assessment for heterogeneity performed. RESULTS We found 23 observational studies involving 186,033 cases that met eligibility criteria. Across studies, 10,307 cases of hospital-acquired CDI were reported. Significant heterogeneity was present; therefore, a random effects model was used. The pooled odds ratio was 1.81 (95% CI, 1.52-2.14), favoring higher risk of CDI with PPI use. Significant heterogeneity was present, likely due to differences in assessment of exposure, study population, and definition of CDI. DISCUSSION This meta-analysis suggests PPIs significantly increase the risk of hospital-acquired CDI. Given the significant health and economic burden of CDI and the risks of PPI, optimization of PPI use should be included in a multifaceted approach to CDI prevention. Infect Control Hosp Epidemiol 2016;1408-1417
引用
收藏
页码:1408 / 1417
页数:10
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