Inappropriato uso di PPI e rischio di infezione da C.difficile

Proton Pump Inhibitors (PPI) significantly increase the risk of Clostridium difficile infection in a Low Endemicity, Non-outbreak Hospital Setting: optimizing risk and benefit of PPI therapy.Dalton BR, Lye-Maccannell T, Henderson EA, Maccannel DR, Louie TJ. Aliment Pharmacol Ther. 2008 Dec 19. [Epub ahead of print]  Background: Proton pump inhibitors (PPI) have been linked to higher risk of Clostridium difficile infection (CDI). The relevance of this association in hospitals with low disease activity, where an outbreak strain is non-dominant, has been assessed in relatively few studies. Aim: To assess the association of PPI and CDI in a setting of low disease activity. Methods: A retrospective cohort study was conducted at two hospitals. Patients admitted for greater than or equal to 7 days receiving antibiotics were included. Demographics, exposure to PPI, antibiotics and other drugs in relation to diagnosis of CDI were assessed by univariate and multivariate analyses. Results: Of 14, 719 patients, 149 (1.01%) first episode CDI were documented; PPI co-exposure increased CDI (1.44 cases/ 100 patients versus 0.74 cases/ 100 non-exposed [OR = 1.96, 95% CI 1.42-2.72]). By logistic regression, PPI days (adjusted OR 1.01 per day, 95% CI 1.00-1.02), histamine-2 blockers, antidepressants, antibiotic days, exposure to medications, age, admission service and length of admission were significant predictors. Conclusions: A statistically significant increase in CDI was observed in antibiotic recipients who received PPI but the absolute risk increase is modest. In settings of with low rates of CDI, the benefit of PPI therapy outweighs the risk of developing CDI. These data support programs to decrease inappropriate use of PPI in hospitalized patients. . Leggi l’articolo