Hospitalized patients on proton pump inhibitors for stress ulcer prophylaxis have a higher risk of Clostridioides difficile infection compared with those on histamine-2 receptor antagonists

IF 3.9 3区医学 Q1 INFECTIOUS DISEASES Journal of Hospital Infection Pub Date : 2024-10-05 DOI:10.1016/j.jhin.2024.09.016

L-H. Wu , J-L. Wang , Y-H. Liu , C-C. Su , Y-H.K. Yang , S-J. Lin , C-L. Cheng

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Abstract

Background

Previous studies on Clostridioides difficile infection (CDI) in proton pump inhibitor (PPI) users generally enrolled a heterogeneous population and did not include a control group of histamine H2 receptor antagonists (H2RAs) users or adjust for confounding variables, such as previous antibiotics. It is uncertain whether hospitalized patients using PPIs for stress ulcer prophylaxis (SUP) are at a higher risk of CDI compared with those using H2RAs. This study aimed to compare the association between CDI and the usage of antisecretory drugs (ASDs): PPIs and H2RAs, for SUP among hospitalized patients, and the impact of the duration of their use on CDI.

Methods

In this nationwide population-based cohort study using the Taiwan National Health Insurance Database, hospitalized patients using ASDs for SUP were identified between 2017 and 2018. A total of 63,266 and 69,269 individuals were included in the PPI and H2RA groups, respectively. The primary endpoint was a 90-day monitoring of CDI occurrence.

Findings

The incidences of CDI were 1.6/10,000 and 0.5/10,000 person-days in the PPIs and H2RAs groups, respectively. After adjusting for confounding factors, the risk of infection in the PPIs group remained significantly higher than in the H2RAs group (hazard ratio (HR), 2.49; 95% confidence interval (CI), 1.63–3.81). In the subgroup analysis, during hospitalization, the risk of CDI for patients using high-risk antibiotics or admitted to the intensive care unit (ICU), as well as patients with immunodeficiency, using PPIs for SUP, was higher than using H2RAs. Furthermore, the risk of CDI was higher in patients using ASDs for durations >14 days than in those using them for <7 days (adjusted HR, 3.66; 95% CI, 2.34–5.75).

Conclusions

The risk of occurrence CDI for hospitalized patients using PPIs for SUP was higher than using H2RAs. It is recommended not to exceed 14 days of any gastric ASDs for SUP during hospitalization, especially for patients who have used high-risk antibiotics, have been admitted to the ICU, or have immunodeficiency.

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与服用组胺-2 受体拮抗剂的患者相比，服用质子泵抑制剂预防应激性溃疡的住院患者感染艰难梭菌的风险更高。

背景：以往关于质子泵抑制剂（PPIs）使用者艰难梭菌感染（CDI）的研究一般都是在不同人群中进行的，并没有包括组胺 H2 受体拮抗剂（H2RAs）使用者对照组，也没有对既往使用过抗生素等混杂变量进行调整。与使用 H2RAs 的患者相比，使用 PPIs 预防应激性溃疡（SUP）的住院患者是否具有更高的 CDI 风险尚不确定。本研究旨在比较 CDI 与抗分泌药物 (ASD) 使用之间的关系：方法：在这项基于人口的全国性队列研究中，使用了台湾国民健康保险数据库，确定了 2017-2018 年间使用 ASDs 进行 SUP 的住院患者。PPI组和H2RA组分别纳入了63266人和69269人。主要终点是90天的CDI发生率监测：PPIs组和H2RAs组的CDI发病率分别为1-6/10,000人天和0-5/10,000人天。调整混杂因素后，PPIs 组的感染风险仍显著高于 H2RAs 组（危险比 [HR]，2-49；95% 置信区间 [CI]，1-63-3-81）。在亚组分析中，在住院期间，使用高风险抗生素或入住重症监护室（ICU）的患者以及免疫缺陷患者使用 PPIs SUP 的 CDI 风险高于使用 H2RAs 的患者。此外，使用ASDs时间大于14天的患者发生CDI的风险高于使用ASDs时间小于7天的患者（调整后HR，3-66；95% CI，2-34-5-75）：结论：使用 PPIs 治疗 SUP 的住院患者发生 CDI 的风险高于使用 H2RAs 的患者。建议住院期间使用任何胃药ASD治疗SUP的时间不要超过14天，尤其是使用过高风险抗生素、住过重症监护室或有免疫缺陷的患者。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Hospital Infection 医学-传染病学

CiteScore

12.70

自引率

5.80%

发文量

271

审稿时长

19 days

期刊介绍： The Journal of Hospital Infection is the editorially independent scientific publication of the Healthcare Infection Society. The aim of the Journal is to publish high quality research and information relating to infection prevention and control that is relevant to an international audience. The Journal welcomes submissions that relate to all aspects of infection prevention and control in healthcare settings. This includes submissions that: provide new insight into the epidemiology, surveillance, or prevention and control of healthcare-associated infections and antimicrobial resistance in healthcare settings; provide new insight into cleaning, disinfection and decontamination; provide new insight into the design of healthcare premises; describe novel aspects of outbreaks of infection; throw light on techniques for effective antimicrobial stewardship; describe novel techniques (laboratory-based or point of care) for the detection of infection or antimicrobial resistance in the healthcare setting, particularly if these can be used to facilitate infection prevention and control; improve understanding of the motivations of safe healthcare behaviour, or describe techniques for achieving behavioural and cultural change; improve understanding of the use of IT systems in infection surveillance and prevention and control.