ArticleThe American journal of gastroenterology2016
Proton Pump Inhibitors Do Not Increase Risk for Clostridium difficile Infection in the Intensive Care Unit.
Article in The American journal of gastroenterology, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 24 papers, 3 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
24 citing papers in PubMed, 3 syntheses or guidelines pooled it, 59 citations in OpenAlex.
- Association between Proton Pump Inhibitor andDigestive diseases (Basel, Switzerland) · 2026Pooled it
- Magnitude and direction of the association between Clostridium difficile infection and proton pump inhibitors in adults and pediatric patients: a systematic review and meta-analysis.Journal of gastroenterology · 2018Pooled it
- Proton pump inhibitors therapy and risk of Clostridium difficile infection: Systematic review and meta-analysis.World journal of gastroenterology · 2017Pooled it
- The Influence of Proton Pump Inhibitors on the Fecal Microbiome of Infants with Gastroesophageal Reflux-A Prospective Longitudinal Interventional Study.Frontiers in cellular and infection microbiology · 2017Trial
- A Systematic Literature Review on Risk Factors for and Timing of Clostridioides difficile Infection in the United States.Infectious diseases and therapy · 2024Review
- A Retrospective Cohort Analysis of the Use of Enteral Nutrition Plus Pharmacologic Prophylaxis or Enteral Nutrition Alone.Hospital pharmacy · 2021Article
- The efficacy and safety of acid suppressants for gastrointestinal bleeding prophylaxis in cardiac care unit patients.Journal of gastroenterology and hepatology · 2021Article
- Comparison between esomeprazole 20 mg Vs 40 mg as stress ulcer prophylaxis (SUP) in critically ill patients: A retrospective cohort study.Pharmacology research & perspectives · 2020Article
- From Nursery to Nursing Home: Emerging Concepts in Clostridioides difficile Pathogenesis.Infection and immunity · 2020Review
- [Clostridium difficile in the intensive care unit].Medizinische Klinik, Intensivmedizin und Notfallmedizin · 2020Review
- Review
- Intestinal Microbiota in Elderly Inpatients withInfection and drug resistance · 2020Article
- Article
- Risk Factors for PrimaryFrontiers in public health · 2020Observational
- Initial therapy affects duration of diarrhoea in critically ill patients with Clostridioides difficile infection (CDI).Critical care (London, England) · 2019Article
- Hospital-level high-risk antibiotic use in relation to hospital-associatedInfection control and hospital epidemiology · 2019Article
- Proton pump inhibitors and 180-day mortality in the elderly afterGut pathogens · 2019Article
- Proton-pump inhibitors do not influence clinical outcomes in patients withTherapeutic advances in gastroenterology · 2019Article
- The local hospital milieu and healthcare-associated vancomycin-resistant enterococcus acquisition.The Journal of hospital infection · 2019Article
- Advantages and Disadvantages of Long-term Proton Pump Inhibitor Use.Journal of neurogastroenterology and motility · 2018Review
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Authors and funding
6 authors at 2 institutions in 1 country.
Funding
Abstract
objectivesPatients in the intensive care unit (ICU) frequently receive proton pump inhibitors (PPIs) and have high rates of Clostridium difficile infection (CDI). PPIs have been associated with CDI in hospitalized patients, but ICU patients differ fundamentally from non-ICU patients and few studies have focused on PPI use exclusively in the critical care setting. We performed a retrospective cohort study to determine the associations between PPIs and health-care facility-onset CDI in the ICU.
methodsWe analyzed data from all adult ICU patients at three affiliated hospitals (14 ICUs) between 2010 and 2013. Patients were excluded if they had recent CDI or an ICU stay of <3 days. We parsed electronic medical records for ICU exposures, focusing on PPIs and other potentially modifiable exposures that occurred during ICU stays. Health-care facility-onset CDI in the ICU was defined as a newly positive PCR for the C. difficile toxin B gene from an unformed stool, with subsequent receipt of anti-CDI therapy. We analyzed PPIs and other exposures as time-varying covariates and used Cox proportional hazards models to adjust for demographics, comorbidities, and other clinical factors.
resultsOf 18,134 patients who met the criteria for inclusion, 271 (1.5%) developed health-care facility-onset CDI in the ICU. Receipt of antibiotics was the strongest risk factor for CDI (adjusted HR (aHR) 2.79; 95% confidence interval (CI), 1.50-5.19). There was no significant increase in risk for CDI associated with PPIs in those who did not receive antibiotics (aHR 1.56; 95% CI, 0.72-3.35), and PPIs were actually associated with a decreased risk for CDI in those who received antibiotics (aHR 0.64; 95% CI, 0.48-0.83). There was also no evidence of increased risk for CDI in those who received higher doses of PPIs.
conclusionsExposure to antibiotics was the most important risk factor for health-care facility-onset CDI in the ICU. PPIs did not increase risk for CDI in the ICU regardless of use of antibiotics.
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