Clinical Review

Association Between Proton Pump Inhibitor Exposure and Clostridium difficile Infection in Elderly, Hospitalized Patients

Fed Pract. 2015 November;32(11):21-25

References

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Data were not collected on the duration of PPI therapy. A longer duration of therapy has been shown in previous studies to be significantly associated with CDI.²⁶ It is unclear in this patient population whether there would have been an association between PPI duration of treatment and CDI.

Outpatient PPI exposure was determined using CPRS refill history. Patients were considered to have PPI exposure if they filled ≥ 1 prescription for a PPI within 2 months of hospitalization. Using this methodology to determine PPI exposure may not have identified patients who took over-the-counter PPIs or did not report filling a prescription for a PPI from an outside pharmacy, which would have resulted in an underestimation of PPI use in this sample. Furthermore, it is difficult to determine adherence to a prescribed regimen for outpatients.

Pantoprazole and omeprazole are the formulary PPIs at the study site. Conducting research at an institution with a formulary prevents evaluation of other PPIs, including esomeprazole, rabeprazole, dexlansoprazole, and lansoprazole. This is not seen as a significant limitation, as there have not been significant differences in the PPI agent and CDI widely reported in the literature.

Data on H2RA exposure were not collected. Any possible effect of H2RA exposure and CDI cannot be accounted for in this study. It is not likely that H2RA exposure would be associated with an increased risk of CDI in this patient population, as several studies have shown less of an association between CDI and H2RA compared with CDI and PPI use.

Further investigation to evaluate the association between CDI and PPI exposure in an elderly, hospitalized population is needed. Larger studies  in these patients that evaluate duration of PPI therapy would be beneficial.

Conclusion

In an elderly, hospitalized patient population with a high comorbidity burden, this study did not detect a statistically significant association between PPI exposure and CDI. Despite this, providers should continue to consider discontinuation of unnecessary PPI therapy.

Acknowledgements
The authors wish to thank Mehran Salles, PhD, PharmD, for her assistance. Study findings were presented at the 2014 Southeastern Residency Conference in Athens, Georgia, on May 1, 2014.

Author disclosures
The authors report no actual or potential conflicts of interest with regard to this article.

Disclaimer
The opinions expressed herein are those of the authors and do not necessarily reflect those of Federal Practitioner Frontline Medical Communications Inc., the U.S. Government, or any of its agencies. This article may discuss unlabeled or investigational use of certain drugs. Please review complete prescribing information for specific drugs or drug combinations—including indications, contraindications, warnings, and adverse effects—before administering pharmacologic therapy to patients.