From the Journals

PPIs, certain antibiotics increase risk of hospital onset C. difficile infection

Study underscores need for improved stewardship practices

Publish date: January 23, 2018
By
Mark S. Lesney

 

FROM CLINICAL INFECTIOUS DISEASES

The use of proton pump inhibitors increased the odds of a patient having hospital-onset Clostridium difficile infection (HO CDI) as did the use of third- and fourth-generation cephalosporins, carbapenems, and piperacillin/tazobactam, according to the results of a retrospective database study of more than 1 million patients at 150 U.S. hospitals.

PPIs increased the odds of HO CDI by 44% (P less than .001), whereas the use of H2 antagonists increased the odds ratio for HO CDI to a lesser, but still significant, extent (13% increase, P less than .001), according to the report published online in Clinical Infectious Diseases.

Overall, the odds of HO CDI were significantly higher in patients taking carbapenems, third- and fourth-generation cephalosporins, metronidazole, and piperacillin/tazobactam, as well as patients on multiple antibiotics. However, treatment with tetracyclines, macrolides, or clindamycin significantly reduced the odds of HO CDI.

The combination of PPIs with fluoroquinolones, third-generation cephalosporins, fourth-generation cephalosporins, clindamycin, or carbapenems did not significantly alter the odds of HO CDI, which was in contrast with a previous meta-analysis (Am J Gastroenterol. 2012;107[7]:1011-9).

This illustration depicts the ultrastructural morphology exhibited by a single Gram-positive Clostridium difficile bacillus. CDC/Jennifer Hulsey
“Whether or not there are common pathways by which these medications increase the risk for development of a CDI remains to be determined,” the authors stated. “This study leveraged a large database and confirms and supports previous studies demonstrating an increased odds of HO CDI associated with the use of PPIs and certain high-risk antibiotics,” noted Troy Watson, PharmD, and his colleagues at the Hospital Corporation of America, Nashville, Tenn.

In addition to the drug associations, the odds of a patient having HO CDI increased by 0.5% for each year in age. The odds of CDI in women was 1.2 times as likely as in men, and admission from a long-term care facility, the presence of the comorbidities of diabetes, Crohn’s disease or ulcerative colitis, as well as days in the ICU and antibiotic days of therapy all significantly increased the odds of a patient having HO CDI. (Clin Infect Dis. 2017 Dec. 20. doi: 10.1093/cid/cix1112).

“The results support the need for stewardship practices around both high-risk antibiotics and medications that alter gastric acid regulation. Furthermore, the impact of deprescribing acid suppression therapy coupled with antibiotic stewardship could greatly reduce the incidence of HO CDI,” the researchers concluded.

The authors reported that they had no conflicts or funding source for this work.

SOURCE: Watson, T. et al. Clin Infect Dis. 2017 Dec. 20. doi: 10.1093/cid/cix1112.

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