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• W2149675013 abstract "<b>Background:</b> Antibiotic disruption of the normal intestinal flora is a well-known risk factor for <i>Clostridium difficile</i>-associated diarrhea. Reduced gastric acidity has been suggested as a risk factor, and we hypothesized that proton pump inhibitors, because of their potency, may be an independent risk factor for this problem. <b>Methods:</b> For the cohort study we identified from a pharmacy database 1187 inpatients at a Montreal teaching hospital who received antibiotics over a 9-month period beginning in August 2002. We compared patients in this group who had also received a proton pump inhibitor or an H₂ blocker with patients who had not received acid suppressive therapy. Hospital laboratory reports of positive assay results for <i>C. difficile</i> toxin were used to ascertain cases in the cohort. To assess the possibility that proton pump inhibitors were prescribed to patients who were sicker and had other risk factors for <i>C. difficile</i> infection, we did a case–control study at a second Montreal teaching hospital. Cases were defined as patients who were positive for <i>C. difficile</i> toxin and who had a history of diarrhea (<i>n</i> = 94). Control subjects were selected from among patients who had received an antibiotic and were matched to cases by ward, age within 5 years and class of antibiotics (<i>n</i> = 94). <b>Results:</b> In the cohort study, <i>C. difficile</i> diarrhea developed in 81 (6.8%) of the 1187 patients who received antibiotics while in hospital. In a multivariate analysis, <i>C. difficile</i> diarrhea was significantly associated with use of proton pump inhibitors (adjusted odds ratio [OR] 2.1, 95% confidence interval [CI] 1.2– 3.5), receipt of 3 or more antibiotics (OR 2.1, 95% CI 1.3– 3.4) and admission to a medical ward (OR 4.1, 95% CI 2.3– 7.3). In the case–control study <i>C. difficile</i> diarrhea was associated with female sex (adjusted OR 2.1, 95% CI 1.1–4.0), prior renal failure (adjusted OR 4.3, 95% CI 1.5–11.9), hospital admission in the 3 months before the index admission (adjusted OR 2.6, 95% CI 1.4–5.2) and use of proton pump inhibitors (adjusted OR 2.7, 95% CI 1.4–5.2). <b>Interpretation:</b> Patients in hospital who received proton pump inhibitors were at increased risk of <i>C. difficile</i> diarrhea." @default.
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• W2149675013 date "2004-07-06" @default.
• W2149675013 modified "2023-09-24" @default.
• W2149675013 title "Risk of Clostridium difficile diarrhea among hospital inpatients prescribed proton pump inhibitors: cohort and case-control studies" @default.
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• W2149675013 doi "https://doi.org/10.1503/cmaj.1040876" @default.
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