Wednesday, November 09, 2011
pancreas
Howell MD, Novack V, Grgurich P, et al
Arch Intern Med. 2010;170:784-790
Study Summaries
The incidence and severity of Clostridium difficile infections (CDI) are increasing at an alarming rate. Because the gastric acid barrier is one of the defense mechanisms for protecting the integrity of the normal gut microflora environment, acid-suppression therapy has beensuggested as treatment for a number of intestinal pathogenic infections -- including C difficile -- but this remains controversial.
These 2 reports suggest that the increased risk for CDI with proton pump inhibitors (PPIs) is not at all modest, and that gastric acid is potentially important in protecting against infection from this pathogen.
The study by Linsky and colleagues is a pharmacoepidemiologic cohort trial in which a secondary analysis was performed with data collected prospectively on 101,796 patients discharged from a tertiary care medical center during a 5-year period. As use of acid-suppression therapy increased, the reported risk for nosocomial CDI also increased, from 0.3% (95% confidence interval [CI], 0.21%-0.31%) in patients who did not receive acid-suppression therapy, to 0.6% (95% CI, 0.49%-0.79%) in those who did receive histamine2-receptor antagonist (H2RA) therapy, to 0.9% (95% CI, 0.80%-0.98%) in patients who received daily PPI treatment, and to 1.4% (1.15%-1.71%) in those who received more frequent PPI therapy.
