Use of gastric acid-suppressive agents and the risk of community-acquired Clostridium difficile-associated disease
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TLDR
The use of acid-suppressive therapy, particularly proton pump inhibitors, is associated with an increased risk of community-acquired C difficile and the unexpected increase in risk with nonsteroidal anti-inflammatory drug use should be investigated further.Abstract:
ContextRecent reports suggest an increasing occurrence and severity of Clostridium difficile–associated disease. We assessed whether the use of gastric acid–suppressive agents is associated with an increased risk in the community.ObjectiveTo determine whether the use of gastric acid–suppressive agents increases the risk of C difficile–associated disease in a community population.Design, Setting, and PatientsWe conducted 2 population-based case-control studies using the United Kingdom General Practice Research Database (GPRD). In the first study, we identified all 1672 cases of C difficile recorded between 1994 and 2004 among all patients registered for at least 2 years in each practice. Each case was matched to 10 controls on calendar time and the general practice. In the second study, a subset of these cases defined as community-acquired, that is, not hospitalized in the prior year, were matched on practice and age with controls also not hospitalized in the prior year.Main Outcome MeasuresThe incidence of C difficile and risk associated with gastric acid–suppressive agent use.ResultsThe incidence of C difficile in patients diagnosed by their general practitioners in the General Practice Research Database increased from less than 1 case per 100 000 in 1994 to 22 per 100 000 in 2004. The adjusted rate ratio of C difficile–associated disease with current use of proton pump inhibitors was 2.9 (95% confidence interval [CI], 2.4-3.4) and with H2-receptor antagonists the rate ratio was 2.0 (95% CI, 1.6-2.7). An elevated rate was also found with the use of nonsteroidal anti-inflammatory drugs (rate ratio, 1.3; 95% CI, 1.2-1.5).ConclusionsThe use of acid-suppressive therapy, particularly proton pump inhibitors, is associated with an increased risk of community-acquired C difficile. The unexpected increase in risk with nonsteroidal anti-inflammatory drug use should be investigated further.read more
Citations
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Journal ArticleDOI
Clinical Practice Guidelines for Clostridium difficile Infection in Adults: 2010 Update by the Society for Healthcare Epidemiology of America (SHEA) and the Infectious Diseases Society of America (IDSA)
Stuart H. Cohen,Dale N. Gerding,Stuart Johnson,Ciaran P. Kelly,Vivian G. Loo,L. Clifford McDonald,Jacques Pépin,Mark H. Wilcox +7 more
TL;DR: This guideline updates recommendations regarding epidemiology, diagnosis, treatment, and infection control and environmental management of Clostridium difficile.
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Clinical Practice Guidelines for Clostridium difficile Infection in Adults and Children: 2017 Update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA)
L. Clifford McDonald,Dale N. Gerding,Stuart Johnson,Stuart Johnson,Johan S. Bakken,Karen C. Carroll,Susan E. Coffin,Erik R. Dubberke,Kevin W. Garey,Carolyn V. Gould,Ciaran P. Kelly,Vivian G. Loo,Julia S. Sammons,Thomas J. Sandora,Mark H. Wilcox +14 more
TL;DR: This guideline updates recommendations regarding epidemiology, diagnosis, treatment, infection prevention, and environmental management on Clostridium difficile infection in adults and includes recommendations for children.
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Rachel Rosen,Yvan Vandenplas,Maartje Singendonk,Michael D. Cabana,Carlo DiLorenzo,Frédéric Gottrand,Sandeep K. Gupta,Miranda W. Langendam,Annamaria Staiano,Nikhil Thapar,Neelesh A. Tipnis,Merit M. Tabbers +11 more
TL;DR: This document serves as an update of the North American and European societies for Pediatric Gastroenterology, Hepatology, and Nutrition 2009 clinical guidelines for the diagnosis and management of gastroesophageal reflux disease in infants and children and is intended to be applied in daily practice and as a basis for clinical trials.
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