Gut Liver.  2016 Jul;10(4):581-586. 10.5009/gnl15324.

Risk of Clostridium difficile Infection with the Use of a Proton Pump Inhibitor for Stress Ulcer Prophylaxis in Critically Ill Patients

• Ro Y
• Eun CS
• Kim HS
• Kim JY
• Byun YJ
• Yoo KS
• Han DS

• KMID: 2412047
• DOI: http://doi.org/10.5009/gnl15324

Abstract

BACKGROUND/AIMS
Proton pump inhibitors (PPIs) and histamine-2 receptor antagonists (H2RAs) are commonly prescribed for stress ulcer prophylaxis (SUP) in critically ill patients. Several studies have suggested that the use of PPIs is a potential risk factor for Clostridium difficile infection (CDI). We compared the incidences of CDI in the PPI group and H2RA group for SUP in critically ill patients.
METHODS
From August 2005 to July 2012, the incidences of CDI were retrospectively analyzed in patients who were admitted directly to intensive care units and stayed for more than 3 days. SUP-related CDI was defined as a CDI diagnosed during the SUP period. Patient clinical data were analyzed to identify potential risk factors for SUP-related CDI.
RESULTS
Of the 1,005 patients enrolled (444 patients received PPI and 561 received H2RA), 38 (3.8%) were diagnosed with SUP-related CDI. The incidence of SUP-related CDI was considerably higher in patients who received PPI than in those who received H2RA (6.7% vs 1.8%). PPI use for SUP (odds ratio [OR], 3.3; confidence interval [CI], 1.5 to 7.1; p=0.003) and diabetes mellitus (OR, 2.3; CI, 1.2 to 4.7; p=0.019) were independent risk factors for SUP-related CDI.
CONCLUSIONS
PPI therapy is associated with a higher risk of SUP-related CDI than H2RA therapy in critically ill patients.

Keyword

Clostridium difficile; Proton pump inhibitor; Histamine-2 receptor antagonist; Critical care

MeSH Terms

Aged
Clostridium Infections/*chemically induced/epidemiology
Clostridium difficile/drug effects
Critical Illness/*therapy
Cross Infection/*chemically induced/epidemiology
Female
Humans
Incidence
Male
Middle Aged
Odds Ratio
Pressure Ulcer/*prevention & control
Proton Pump Inhibitors/*adverse effects
Retrospective Studies
Risk Factors
Proton Pump Inhibitors