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Iatrogenic Gastric Acid Suppression and the Risk of Nosocomial Clostridium difficileInfection

Iatrogenic Gastric Acid Suppression and the Risk of Nosocomial Clostridium difficileInfection ORIGINAL INVESTIGATION LESS IS MORE Iatrogenic Gastric Acid Suppression and the Risk of Nosocomial Clostridium difficile Infection Michael D. Howell, MD, MPH; Victor Novack, MD, PhD; Philip Grgurich, PharmD; Diane Soulliard, PharmD; Lena Novack, PhD; Michael Pencina, PhD; Daniel Talmor, MD, MPH Background: The incidence and severity of Clos- 0.9% (95% CI, 0.80%-0.98%) in those receiving daily PPI tridium difficile infections are increasing. Acid- treatment, and to 1.4% (1.15%-1.71%) in those receiv- suppressive therapy has been suggested as a risk factor ing more frequent PPI therapy. After adjustment for co- for C difficile, but this remains controversial. morbid conditions, age, antibiotics, and propensity score– based likelihood of receipt of acid-suppression therapy, Methods: We conducted a pharmacoepidemiologic co- the association persisted, increasing from an odds ratio hort study, performing a secondary analysis of data col- of 1 (no acid suppression [reference]) to 1.53 (95% CI, lected prospectively on 101 796 discharges from a ter- 1.12-2.10) (H RA), to 1.74 (95% CI, 1.39-2.18) (daily tiary care medical center during a 5-year period. The PPI), and to 2.36 (95% CI, 1.79-3.11) (more frequent PPI). primary exposure of interest was acid suppression therapy, Similar estimates were found with a matched cohort analy- classified http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png JAMA Internal Medicine American Medical Association

Iatrogenic Gastric Acid Suppression and the Risk of Nosocomial Clostridium difficileInfection

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Publisher
American Medical Association
Copyright
Copyright 2010 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.
ISSN
2168-6106
eISSN
2168-6114
DOI
10.1001/archinternmed.2010.89
pmid
20458086
Publisher site
See Article on Publisher Site

Abstract

ORIGINAL INVESTIGATION LESS IS MORE Iatrogenic Gastric Acid Suppression and the Risk of Nosocomial Clostridium difficile Infection Michael D. Howell, MD, MPH; Victor Novack, MD, PhD; Philip Grgurich, PharmD; Diane Soulliard, PharmD; Lena Novack, PhD; Michael Pencina, PhD; Daniel Talmor, MD, MPH Background: The incidence and severity of Clos- 0.9% (95% CI, 0.80%-0.98%) in those receiving daily PPI tridium difficile infections are increasing. Acid- treatment, and to 1.4% (1.15%-1.71%) in those receiv- suppressive therapy has been suggested as a risk factor ing more frequent PPI therapy. After adjustment for co- for C difficile, but this remains controversial. morbid conditions, age, antibiotics, and propensity score– based likelihood of receipt of acid-suppression therapy, Methods: We conducted a pharmacoepidemiologic co- the association persisted, increasing from an odds ratio hort study, performing a secondary analysis of data col- of 1 (no acid suppression [reference]) to 1.53 (95% CI, lected prospectively on 101 796 discharges from a ter- 1.12-2.10) (H RA), to 1.74 (95% CI, 1.39-2.18) (daily tiary care medical center during a 5-year period. The PPI), and to 2.36 (95% CI, 1.79-3.11) (more frequent PPI). primary exposure of interest was acid suppression therapy, Similar estimates were found with a matched cohort analy- classified

Journal

JAMA Internal MedicineAmerican Medical Association

Published: May 10, 2010

References