Assessing the Risk of Hospital-AcquiredClostridium DifficileInfection With Proton Pump Inhibitor Use: A Meta-Analysis

Abstract

BACKGROUNDClostridium difficileis the principal infectious cause of antibiotic-associated diarrhea and accounts for 12% of hospital-acquired infections. Recent literature has shown an increased risk ofC. difficileinfection (CDI) with proton pump inhibitor (PPI) use.OBJECTIVETo conduct a systematic assessment of the risk of hospital-acquired CDI following exposure to PPI.METHODSWe searched multiple databases for studies examining the relationship between PPI and hospital-acquired CDI. Pooled odds ratios were generated and assessment for heterogeneity performed.RESULTSWe found 23 observational studies involving 186,033 cases that met eligibility criteria. Across studies, 10,307 cases of hospital-acquired CDI were reported. Significant heterogeneity was present; therefore, a random effects model was used. The pooled odds ratio was 1.81 (95% CI, 1.52–2.14), favoring higher risk of CDI with PPI use. Significant heterogeneity was present, likely due to differences in assessment of exposure, study population, and definition of CDI.DISCUSSIONThis meta-analysis suggests PPIs significantly increase the risk of hospital-acquired CDI. Given the significant health and economic burden of CDI and the risks of PPI, optimization of PPI use should be included in a multifaceted approach to CDI prevention.Infect Control Hosp Epidemiol2016;1408–1417