Proton pump inhibitors increase the risk for hospital-acquired Clostridium difficile infection in critically ill patientsReportar como inadecuado

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Critical Care

, 18:714

First Online: 24 December 2014Received: 25 September 2014Accepted: 08 December 2014


IntroductionProton pump inhibitors PPI have been linked to Clostridium difficile infection CDI but there are few data specific to ICU patients. We evaluated duration of PPI exposure as a potential risk factor for hospital-acquired CDI in the ICU.

MethodsThis retrospective, case-control study was conducted using the Multiparameter Intelligent Monitoring in Intensive Care II database, a large publically available database of more than 35,000 ICU patients. Adult patients with CDI were identified using the ICD-9 code for Clostridium difficile listed as a secondary diagnosis. To be included, patients had to be present in an ICU for ≥48 hours prior to Clostridium difficile acquisition. These patients were then matched to patients without CDI using the ICD-9 primary diagnosis, age +-−5 years and SOFA score +-−1. Successfully matched patients were reviewed for PPI exposure and other potential confounding variables for CDI. PPI exposure was characterized as short <2 days or long ≥2 days. Multivariate modeling was performed to identify independent risk factors for CDI.

ResultsThere were 408 patients evaluated and 81% received a PPI. The percentage of patients who had a long exposure to PPIs was 83% in the CDI group compared to 73% with controls P = 0.012. Upon inclusion of the following variables into a multivariate analysis long PPI exposure, histamine-2-receptor antagonist administration, antibiotic administration, immunosuppression and study duration, long PPI exposure odds ratio OR 95% confidence interval CI = 2.03 1.23 to 3.36, P = 0.006 and antibiotic use OR 95% CI = 2.52 1.23 to 5.18, P = 0.012 were identified as independent predictors of CDI.

ConclusionsProton pump inhibitors are independent risk factors for the development of CDI in ICU patients. This risk is particularly exposed after two or more days of therapy.

AbbreviationsCDIClostridium difficile infection

CIconfidence interval


H2RAhistamine 2 receptor antagonist

ICD-9International Classification of Diseases, Ninth Revision

ICUintensive care unit

MIMIC IIMultiparameter Intelligent Monitoring in Intensive Care II

ORodds ratio

PPIproton pump inhibitor

SOFASequential Organ Failure Assessment

SUPstress ulcer prophylaxis

Electronic supplementary materialThe online version of this article doi:10.1186-s13054-014-0714-7 contains supplementary material, which is available to authorized users.

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Autor: Jeffrey F Barletta - David A Sclar


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