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Iatrogenic gastric acid suppression and the risk of nosocomial Clostridium difficile infection.

Publication ,  Journal Article
Howell, MD; Novack, V; Grgurich, P; Soulliard, D; Novack, L; Pencina, M; Talmor, D
Published in: Arch Intern Med
May 10, 2010

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.

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Published In

Arch Intern Med

DOI

EISSN

1538-3679

Publication Date

May 10, 2010

Volume

170

Issue

9

Start / End Page

784 / 790

Location

United States

Related Subject Headings

  • Risk Factors
  • Proton Pump Inhibitors
  • Prospective Studies
  • Propensity Score
  • Multivariate Analysis
  • Matched-Pair Analysis
  • Male
  • Kaplan-Meier Estimate
  • Humans
  • Histamine H2 Antagonists
 

Citation

APA
Chicago
ICMJE
MLA
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Howell, M. D., Novack, V., Grgurich, P., Soulliard, D., Novack, L., Pencina, M., & Talmor, D. (2010). Iatrogenic gastric acid suppression and the risk of nosocomial Clostridium difficile infection. Arch Intern Med, 170(9), 784–790. https://doi.org/10.1001/archinternmed.2010.89
Howell, Michael D., Victor Novack, Philip Grgurich, Diane Soulliard, Lena Novack, Michael Pencina, and Daniel Talmor. “Iatrogenic gastric acid suppression and the risk of nosocomial Clostridium difficile infection.Arch Intern Med 170, no. 9 (May 10, 2010): 784–90. https://doi.org/10.1001/archinternmed.2010.89.
Howell MD, Novack V, Grgurich P, Soulliard D, Novack L, Pencina M, et al. Iatrogenic gastric acid suppression and the risk of nosocomial Clostridium difficile infection. Arch Intern Med. 2010 May 10;170(9):784–90.
Howell, Michael D., et al. “Iatrogenic gastric acid suppression and the risk of nosocomial Clostridium difficile infection.Arch Intern Med, vol. 170, no. 9, May 2010, pp. 784–90. Pubmed, doi:10.1001/archinternmed.2010.89.
Howell MD, Novack V, Grgurich P, Soulliard D, Novack L, Pencina M, Talmor D. Iatrogenic gastric acid suppression and the risk of nosocomial Clostridium difficile infection. Arch Intern Med. 2010 May 10;170(9):784–790.

Published In

Arch Intern Med

DOI

EISSN

1538-3679

Publication Date

May 10, 2010

Volume

170

Issue

9

Start / End Page

784 / 790

Location

United States

Related Subject Headings

  • Risk Factors
  • Proton Pump Inhibitors
  • Prospective Studies
  • Propensity Score
  • Multivariate Analysis
  • Matched-Pair Analysis
  • Male
  • Kaplan-Meier Estimate
  • Humans
  • Histamine H2 Antagonists