Increased Risk of Spontaneous Bacterial Peritonitis in Cirrhotic Patients Using Proton Pump Inhibitors.

Area of Science:

• Hepatology
• Infectious Diseases
• Pharmacology

Background:

• The relationship between proton pump inhibitors (PPIs) and bacterial infections in cirrhotic patients remains debated.
• Previous studies have yielded inconclusive results regarding this association.

Purpose of the Study:

• To investigate the association between PPI use and the incidence of spontaneous bacterial peritonitis (SBP) and other bacterial infections in patients with cirrhosis.
• To identify risk factors for bacterial infections in hospitalized cirrhotic patients.

Main Methods:

• A cohort of 333 cirrhotic patients hospitalized between 2007 and 2012 were classified as PPI users or non-users based on consumption in the 90 days prior to admission.
• Cirrhosis diagnosis was confirmed through clinical, biochemical, radiological, endoscopic, or biopsy findings.

Main Results:

• PPI users (51.4%) exhibited a significantly higher incidence of overall bacterial infection (38%) compared to non-users (13.6%) (p=0.0001).
• Specific increases in SBP (p=0.0006) and chest infections (p=0.01) were noted in PPI users.
• Multivariate analysis identified PPI use (OR=2.149) and older age (>60 years) as independent predictors for SBP and overall bacterial infections.

Conclusions:

• Proton pump inhibitor use and older age (>60 years) are independent risk factors for developing SBP and other bacterial infections in hospitalized cirrhotic patients.
• PPI therapy should be used judiciously in cirrhotic patients, particularly those over 60, unless clinically indicated.