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A Protocol to Characterize the Morphological Changes of Clostridium difficile in Response to Antibiotic Treatment
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Acid Suppression Medications During Hospitalization as a Risk Factor for Recurrence of Clostridioides difficile

Palna Mehta1, Ronald G Nahass2,3, Luigi Brunetti1,4

  • 1Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey; Piscataway, New Jersey, USA.

Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America
|May 10, 2020
PubMed
Abstract

Insights

Acid-suppression medications (ASMs) increase the risk of recurrent Clostridioides difficile infection (CDI) in hospitalized patients. Proton pump inhibitor (PPI) use showed a greater association with recurrent CDI. Further research is needed.

Area of Science:

  • Infectious Diseases
  • Pharmacology
  • Clinical Medicine

Background:

  • Conflicting results exist regarding the impact of acid-suppression medications (ASMs) on recurrent Clostridioides difficile infection (CDI) in hospitalized patients.
  • ASMs are commonly prescribed, making their potential role in CDI recurrence a significant clinical concern.

Purpose of the Study:

  • To systematically review and meta-analyze the association between ASM use during hospitalization and the recurrence of CDI.
  • To quantify the risk of recurrent CDI associated with ASM use, specifically examining proton pump inhibitors (PPIs).

Main Methods:

  • Systematic review and meta-analysis of human studies identified via Medline, Google Scholar, and Web of Science.
  • Inclusion of case-control, cohort studies, and clinical trials; exclusion of reviews and commentaries.
  • Random-effects model used due to identified study heterogeneity; subgroup analyses performed for sensitivity.

Main Results:

  • Nine studies involving 5668 patients revealed that 17.7% developed recurrent CDI.
  • Patients on ASMs had a 64% increased likelihood of recurrent CDI compared to those not on ASMs (OR, 1.64; P = .009).
  • Proton pump inhibitor (PPI) use was linked to an 84% increased risk of recurrent CDI versus no ASM (OR, 1.84; P = .007).

Conclusions:

  • Hospitalization ASM use is associated with a 64% increase in recurrent CDI, with a more pronounced effect from PPIs.
  • Significant heterogeneity necessitates further research to fully understand the iatrogenic effects of ASMs.
  • Discontinuation of unnecessary PPI use is recommended to mitigate potential risks.
Keywords:
Clostridioides difficile infectionacid suppressionhistamine 2 receptor antagonistsmeta-analysisproton pump inhibitors

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