 Advertisement | ||||||||
 | ||||||||
|
||||||||
 |
 |
 |
 |
 |
 |
 |
||
|
From the Division of Clinical Epidemiology, Royal Victoria Hospital, McGill University Health Centre, and the Department of Epidemiology and Biostatistics, McGill University, Montréal, Que. (all authors)
Correspondence to: Dr. Sandra Dial, Division of Clinical Epidemiology, Royal Victoria Hospital, 687 Pine Ave. W, Ross 4.29, Montréal QC H3A 1A1; fax 514 843-1493; sandra.dial{at}mcgill.ca
Background: The association between the use of proton pump inhibitors and the risk of Clostridium difficile-associated disease (CDAD) is controversial. In this study we re-examined a previously reported association between the use of proton pump inhibitors and the development of community-acquired CDAD, this time using an alternative case definition of the disease.
Methods: We performed a case–control study of community-acquired CDAD using a United Kingdom clinical research database. Patients receiving oral vancomycin therapy were identified as having CDAD, the only indication for this drug. Each case subject was matched with up to 10 control subjects. Neither the cases nor the controls had been admitted to hospital in the year before the date of the vancomycin prescription (index date). Conditional logistic regression analysis was used to adjust for key covariates.
Results: We identified 317 cases of community-acquired CDAD treated with oral vancomycin therapy and 3167 matched control subjects. Exposure to a proton pump inhibitor in the 90 days before the index date was associated with an increased risk of CDAD (odds ratio [OR] 3.5, 95% confidence interval [CI] 2.3–5.2). Antibiotic exposure in the 90 days before the index date was also a significant risk factor for community-acquired CDAD (OR 8.2, 95% CI 6.1– 11.0), even though 45% of the case subjects had not received a prescription for an antibiotic during that period. Certain comorbidities, in particular renal failure, inflammatory bowel disease and malignant disease, as well as prior methicillin-resistant Staphylococcus aureus infection, were also associated with an increased risk.
Interpretation: Proton pump inhibitor use was associated with an increased risk of community-acquired CDAD, when cases were defined by receipt of prescription for oral vancomycin therapy. Prior antibiotic exposure was also a significant risk factor, but a significant proportion of the patients with community-acquired CDAD had no such exposure.
Related Article
This article has been cited by other articles:
|
|
 |
|
  M. M. Nerandzic, M. J. Pultz, and C. J. Donskey Examination of Potential Mechanisms To Explain the Association between Proton Pump Inhibitors and Clostridium difficile Infection Antimicrob. Agents Chemother., October 1, 2009; 53(10): 4133 - 4137. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Dial MD MSc, A. Kezouh PhD, A. Dascal MD, A. Barkun MD MSc, and S. Suissa PhD Patterns of antibiotic use and risk of hospital admission because of Clostridium difficile infection Can. Med. Assoc. J., October 7, 2008; 179(8): 767 - 772. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. H. Wilcox, L. Mooney, R. Bendall, C. D. Settle, and W. N. Fawley A case-control study of community-associated Clostridium difficile infection J. Antimicrob. Chemother., August 1, 2008; 62(2): 388 - 396. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. B. Blossom, F. M.T. Lewis, and L. C. McDonald The Changing Spectrum of Clostridium Difficile Associated Disease: Implications for Dentistry J Am Dent Assoc, January 1, 2008; 139(1): 42 - 47. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. R. Emerson Clostridium difficile Associated Diarrhea, an Emerging Epidemic: Therapeutic Options Journal of Pharmacy Practice, August 1, 2007; 20(4): 347 - 353. [Abstract] [PDF]
|
|
|
|
|
|
R. L. P. Jump, M. J. Pultz, and C. J. Donskey Vegetative Clostridium difficile Survives in Room Air on Moist Surfaces and in Gastric Contents with Reduced Acidity: a Potential Mechanism To Explain the Association between Proton Pump Inhibitors and C. difficile-Associated Diarrhea? Antimicrob. Agents Chemother., August 1, 2007; 51(8): 2883 - 2887. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Porath Possible patient overlap in studies Can. Med. Assoc. J., March 13, 2007; 176(6): 809 - 809. [Full Text] [PDF]
|
|
|
|
|
|
S. Dial and J.A. C. Delaney Possible patient overlap in studies Can. Med. Assoc. J., March 13, 2007; 176(6): 809 - 809. [Full Text] [PDF]
|
|
|
|
 |
|
 S. Jayatilaka, R. Shakov, R. Eddi, G. Bakaj, W. J. Baddoura, and V. A. DeBari Clostridium difficile Infection in an Urban Medical Center: Five-year Analysis of Infection Rates among Adult Admissions and Association with the Use of Proton Pump Inhibitors Ann. Clin. Lab. Sci., January 1, 2007; 37(3): 241 - 247. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. Surowiec, A. G Kuyumjian, M. A Wynd, and C. E Cicogna Past, Present, and Future Therapies for Clostridium difficile-Associated Disease Ann. Pharmacother., December 1, 2006; 40(12): 2155 - 2163. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Do PPIs Increase Risk for Community-Acquired C. difficile Infection? Journal Watch (General), October 24, 2006; 2006(1024): 5 - 5. [Full Text]
|
|
|
|
 |
|
 Minerva BMJ, October 7, 2006; 333(7571): 762 - 762. [Full Text] [PDF]
|
|
|
|
|
|
R. Cunningham Proton pump inhibitors and the risk of Clostridium difficile-associated disease: further evidence from the community. Can. Med. Assoc. J., September 26, 2006; 175(7): 757 - 757. [Full Text] [PDF]
|
|
Read all eLetters
| HOME | CURRENT ISSUE | PAST ISSUES | COLLECTIONS | HELP | SEARCH |
|
|||||
|
Copyright 1995-2006, Canadian Medical Association. All rights reserved. ISSN 1488-2329
(e) 0820-3946 (p)
All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association. |
|||||
