scholarly journals Proton Pump Inhibitors Should be Used with Caution in Critically Ill Patients to Prevent the Risk of Clostridium difficile Infection

Gut and Liver ◽  
2016 ◽  
Vol 10 (4) ◽  
pp. 493-494 ◽  
Author(s):  
Jung Hwa Min ◽  
You Sun Kim
Keyword(s):  
Clostridium Difficile ◽  
Critically Ill ◽  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Clostridium Difficile Infection ◽  
Critically Ill Patients

Implementation of Global Strategies to Prevent Hospital-Onset Clostridium difficile Infection: Targeting Proton Pump Inhibitors and Probiotics

2017 ◽  
Vol 51 (10) ◽  
pp. 848-854 ◽  
Author(s):  
Paul O. Lewis ◽  
Timothy S. Lundberg ◽  
Jennifer L. Tharp ◽  
Clay W. Runnels
Keyword(s):  
Cohort Study ◽  
Clostridium Difficile ◽  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Clostridium Difficile Infection ◽  
Retrospective Cohort ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Order Sets ◽  
Global Strategies

Background: Proton pump inhibitors (PPIs) have been identified as a significant risk factor for the development of Clostridium difficile infection (CDI). Probiotics given concurrently with antibiotics have been shown to have a moderate impact on preventing CDI. Objective: To evaluate the effectiveness of hospital-wide interventions designed to reduce PPI use and increase probiotics and whether these interventions were associated with a change in the incidence of hospital onset (HO)-CDI. Methods: This retrospective cohort study compared 2 fiscal years: July 2013 to June 2014 (FY14) and July 2014 to June 2015 (FY15). In July of FY15, global educational initiatives were launched targeting PPIs. Additionally, a HO-CDI prevention bundle was added to antibiotic-containing order sets targeting probiotics. Overall PPI use, probiotic use, and incidence of HO-CDI were recorded and compared for each cohort. Charts were also reviewed for patients who developed HO-CDI for the presence and appropriateness of a PPI and presence of probiotics. Results: The interventions resulted in a decrease in PPI use by 14% or 96 doses/1000 patient days (TPD; P = 0.0002) and a reduction in IV PPI use by 31% or 71 doses/TPD ( P = 0.0008). Probiotic use increased by 130% or 126 doses/TPD ( P = 0.0006). The incidence of HO-CDI decreased by 20% or 0.1 cases/TPD ( P = 0.04). Conclusions: A collaborative, multifaceted educational initiative directed at highlighting the risks associated with PPI use was effective in reducing PPI prescribing. The implementation of a probiotic bundle added to antibiotic order sets was effective in increasing probiotic use. These interventions were associated with a decrease in incidence of HO-CDI.

Epidemiology and risk factors for Clostridium difficile infection in critically ill patients in Spain: The PROCRID study

2018 ◽  
Vol 36 (4) ◽  
pp. 218-221
Author(s):  
Antonio Gutiérrez-Pizarraya ◽  
Luis Martín-Villén ◽  
Luis Alcalá-Hernández ◽  
Mercedes Marín Arriaza ◽  
Bárbara Balandín-Moreno ◽  
...  
Keyword(s):  
Risk Factors ◽  
Clostridium Difficile ◽  
Critically Ill ◽  
Clostridium Difficile Infection ◽  
Critically Ill Patients

scholarly journals Prolonged Mechanical Ventilation Assistance Interacts Synergistically with Carbapenem for Clostridium difficile Infection in Critically Ill Patients

2018 ◽  
Vol 7 (8) ◽  
pp. 224 ◽  
Author(s):  
Shyh-Ren Chiang ◽  
Chih-Cheng Lai ◽  
Chung-Han Ho ◽  
Chin-Ming Chen ◽  
Chien-Ming Chao ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Clostridium Difficile ◽  
Critically Ill ◽  
Clostridium Difficile Infection ◽  
Critically Ill Patients ◽  
Prolonged Mechanical Ventilation ◽  
Comorbidity Scores ◽  
Independent Risk Factors ◽  
High Comorbidity

Objectives: Interactions between mechanical ventilation (MV) and carbapenem interventions were investigated for the risk of Clostridium difficile infection (CDI) in critically ill patients undergoing concurrent carbapenem therapy. Methods: Taiwan’s National Intensive Care Unit Database (NICUD) was used in this analytical, observational, and retrospective study. We analyzed 267,871 intubated patients in subgroups based on the duration of MV support: 7–14 days (n = 97,525), 15–21 days (n = 52,068), 22–28 days (n = 35,264), and 29–60 days (n = 70,021). The primary outcome was CDI. Results: Age (>75 years old), prolonged MV assistance (>21 days), carbapenem therapy (>15 days), and high comorbidity scores were identified as independent risk factors for developing CDI. CDI risk increased with longer MV support. The highest rate of CDI was in the MV 29–60 days subgroup (adjusted hazard ratio (AHR) = 2.85; 95% confidence interval (CI) = 1.46–5.58; p < 0.02). Moreover, higher CDI rates correlated with the interaction between MV and carbapenem interventions; these CDI risks were increased in the MV 15–21 days (AHR = 2.58; 95% CI = 1.12–5.91) and MV 29–60 days (AHR = 4.63; 95% CI = 1.14–10.03) subgroups than in the non-MV and non-carbapenem subgroups. Conclusions: Both MV support and carbapenem interventions significantly increase the risk that critically ill patients will develop CDI. Moreover, prolonged MV support and carbapenem therapy synergistically induce CDI. These findings provide new insights into the role of MV support in the development of CDI.

Proton pump inhibitors induce changes in colonocyte gene expression that may affect Clostridium difficile infection

Surgery ◽  
2014 ◽  
Vol 156 (4) ◽  
pp. 972-978 ◽  
Author(s):  
John P. Hegarty ◽  
William Sangster ◽  
Leonard R. Harris ◽  
David B. Stewart
Keyword(s):  
Gene Expression ◽  
Clostridium Difficile ◽  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Clostridium Difficile Infection
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