Proton-Pump Inhibitor Use and the Risk of Community-Associated Clostridium difficile Infection
(2021) In Clinical Infectious Diseases 72(12). p.1084-1089- Abstract
Background: Proton-pump inhibitors (PPIs) have been reported to increase the risk of community-associated Clostridium difficile infection (CDI), but the association remains disputed. Methods: A nationwide cohort study among adults in Denmark, 2010-2013, linking register data on C. difficile testing, filled prescriptions, and patient characteristics. All incident episodes of community-associated CDI (ie, positive culture, molecular assay, or toxin test in individuals without previous hospitalization in the prior 12 weeks and without a positive test for C. difficile in the prior 8 weeks) were identified in the Danish National Microbiological Database. Self-controlled case-series analyses were used to estimate incidence rate ratios (IRRs)... (More)
Background: Proton-pump inhibitors (PPIs) have been reported to increase the risk of community-associated Clostridium difficile infection (CDI), but the association remains disputed. Methods: A nationwide cohort study among adults in Denmark, 2010-2013, linking register data on C. difficile testing, filled prescriptions, and patient characteristics. All incident episodes of community-associated CDI (ie, positive culture, molecular assay, or toxin test in individuals without previous hospitalization in the prior 12 weeks and without a positive test for C. difficile in the prior 8 weeks) were identified in the Danish National Microbiological Database. Self-controlled case-series analyses were used to estimate incidence rate ratios (IRRs) for community-associated CDI, comparing periods with and without exposure to PPIs. By design, models took fixed confounders such as chronic disease, genetics, and socioeconomic status into account; further, time-varying confounders, including hospital stay and antibiotic and corticosteroid use were adjusted for. Results: 3583 episodes of community-associated CDI were identified, of which 964 occurred during current use of PPIs, 324 occurred 0-6 months after treatment cessation, 123 occurred 6-12 months after treatment cessation, and 2172 occurred during time periods without use of PPIs. The adjusted IRR was 2.03 (95% confidence interval, 1.74-2.36), comparing use of PPI with nonuse. The increased risk remained elevated in later time periods: 1.54 (1.31-1.80) for 0-6 months, 1.24 (1.00-1.53) for 6-12 months after current use. Conclusions: Use of PPIs was associated with moderately increased risk of community-associated CDI. The risk remained elevated up to 1 year after PPI treatment had ended.
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- author
- Inghammar, Malin LU ; Svanström, Henrik ; Voldstedlund, Marianne ; Melbye, Mads ; Hviid, Anders ; Mølbak, Kåre and Pasternak, Björn LU
- organization
- publishing date
- 2021
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- C. difficile infection, epidemiology, proton-pump inhibitor, self-controlled case-series analysis
- in
- Clinical Infectious Diseases
- volume
- 72
- issue
- 12
- pages
- 1084 - 1089
- publisher
- Oxford University Press
- external identifiers
-
- scopus:85108386940
- pmid:33629099
- ISSN
- 1058-4838
- DOI
- 10.1093/cid/ciaa1857
- language
- English
- LU publication?
- yes
- id
- 4265f07b-206c-49fb-9f4a-6b6e01cfd66f
- date added to LUP
- 2021-07-15 13:33:16
- date last changed
- 2024-06-16 16:06:04
@article{4265f07b-206c-49fb-9f4a-6b6e01cfd66f,
abstract = {{<p>Background: Proton-pump inhibitors (PPIs) have been reported to increase the risk of community-associated Clostridium difficile infection (CDI), but the association remains disputed. Methods: A nationwide cohort study among adults in Denmark, 2010-2013, linking register data on C. difficile testing, filled prescriptions, and patient characteristics. All incident episodes of community-associated CDI (ie, positive culture, molecular assay, or toxin test in individuals without previous hospitalization in the prior 12 weeks and without a positive test for C. difficile in the prior 8 weeks) were identified in the Danish National Microbiological Database. Self-controlled case-series analyses were used to estimate incidence rate ratios (IRRs) for community-associated CDI, comparing periods with and without exposure to PPIs. By design, models took fixed confounders such as chronic disease, genetics, and socioeconomic status into account; further, time-varying confounders, including hospital stay and antibiotic and corticosteroid use were adjusted for. Results: 3583 episodes of community-associated CDI were identified, of which 964 occurred during current use of PPIs, 324 occurred 0-6 months after treatment cessation, 123 occurred 6-12 months after treatment cessation, and 2172 occurred during time periods without use of PPIs. The adjusted IRR was 2.03 (95% confidence interval, 1.74-2.36), comparing use of PPI with nonuse. The increased risk remained elevated in later time periods: 1.54 (1.31-1.80) for 0-6 months, 1.24 (1.00-1.53) for 6-12 months after current use. Conclusions: Use of PPIs was associated with moderately increased risk of community-associated CDI. The risk remained elevated up to 1 year after PPI treatment had ended. </p>}},
author = {{Inghammar, Malin and Svanström, Henrik and Voldstedlund, Marianne and Melbye, Mads and Hviid, Anders and Mølbak, Kåre and Pasternak, Björn}},
issn = {{1058-4838}},
keywords = {{C. difficile infection; epidemiology; proton-pump inhibitor; self-controlled case-series analysis}},
language = {{eng}},
number = {{12}},
pages = {{1084--1089}},
publisher = {{Oxford University Press}},
series = {{Clinical Infectious Diseases}},
title = {{Proton-Pump Inhibitor Use and the Risk of Community-Associated Clostridium difficile Infection}},
url = {{http://dx.doi.org/10.1093/cid/ciaa1857}},
doi = {{10.1093/cid/ciaa1857}},
volume = {{72}},
year = {{2021}},
}