Proton pump inhibitors and 180-day mortality in the elderly after Clostridium difficile treatment
Abstract Background There is a reported association between proton pump inhibitor (PPI) exposure and increased risk of Clostridium difficile infection (CDI), but less is known about how this class of medications taken during treatment might influence mortality after CDI. Here we examine 180-day mort...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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BMC
2019-06-01
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| Series: | Gut Pathogens |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s13099-019-0309-6 |
| _version_ | 1811222717590929408 |
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| author | Evan Stuart Bradley Emily Howe Xun Wu John P. Haran |
| author_facet | Evan Stuart Bradley Emily Howe Xun Wu John P. Haran |
| author_sort | Evan Stuart Bradley |
| collection | DOAJ |
| description | Abstract Background There is a reported association between proton pump inhibitor (PPI) exposure and increased risk of Clostridium difficile infection (CDI), but less is known about how this class of medications taken during treatment might influence mortality after CDI. Here we examine 180-day mortality rates in a cohort of CDI elders and its association with exposure to PPIs. We conducted a retrospective cohort study of elderly patients (> 65 years of age) diagnosed and treated for CDI in the years 2014–2016 (n = 874) in the Umass Memorial Health Care system, which represents both academic and community healthcare. Patient characteristics and medication use was extracted from the electronic medical record (EMR) and 6 month mortality data was obtained via the Center for Disease Control National Death Index. A Cox proportional hazards model was used to estimate hazard ratios associated with medication exposures and other relevant variables. Results Of the 874 elderly adults treated for CDI, 180-day all-cause mortality was 12.4%. Exposure to a PPI was associated with a 55% reduced risk of mortality (adjusted hazard ratio (aHR) 0.45; 95% confidence interval (CI) 0.28–0.72). In our Cox model, increasing age (aHR 1.45; 95% CI 1.14–1.84), those with severe CDI infections (aHR 1.87; 95% CI 1.22–2.88), and those with hospital acquired CDI (aHR 3.01; 95% CI 1.81–4.99) also had increased 180 day mortality risk. There were similar associations noted with both 90 day and 1-year mortality. Conclusion Use of PPIs during CDI treatment in elderly patients is associated with decreased 180-day mortality. Although use of PPIs has been associated with an increased risk of CDI, it appears to be protective against mortality when used during the treatment phase. |
| first_indexed | 2024-04-12T08:19:42Z |
| format | Article |
| id | doaj.art-534248a34f3a4ce9b76aa6fdf8408143 |
| institution | Directory Open Access Journal |
| issn | 1757-4749 |
| language | English |
| last_indexed | 2024-04-12T08:19:42Z |
| publishDate | 2019-06-01 |
| publisher | BMC |
| record_format | Article |
| series | Gut Pathogens |
| spelling | doaj.art-534248a34f3a4ce9b76aa6fdf84081432022-12-22T03:40:37ZengBMCGut Pathogens1757-47492019-06-011111710.1186/s13099-019-0309-6Proton pump inhibitors and 180-day mortality in the elderly after Clostridium difficile treatmentEvan Stuart Bradley0Emily Howe1Xun Wu2John P. Haran3Department of Emergency Medicine, University of Massachusetts Medical School and Umass Memorial Medical CenterUniversity of Massachusetts Medical SchoolUniversity of Massachusetts Medical SchoolDepartment of Emergency Medicine, University of Massachusetts Medical School and Umass Memorial Medical CenterAbstract Background There is a reported association between proton pump inhibitor (PPI) exposure and increased risk of Clostridium difficile infection (CDI), but less is known about how this class of medications taken during treatment might influence mortality after CDI. Here we examine 180-day mortality rates in a cohort of CDI elders and its association with exposure to PPIs. We conducted a retrospective cohort study of elderly patients (> 65 years of age) diagnosed and treated for CDI in the years 2014–2016 (n = 874) in the Umass Memorial Health Care system, which represents both academic and community healthcare. Patient characteristics and medication use was extracted from the electronic medical record (EMR) and 6 month mortality data was obtained via the Center for Disease Control National Death Index. A Cox proportional hazards model was used to estimate hazard ratios associated with medication exposures and other relevant variables. Results Of the 874 elderly adults treated for CDI, 180-day all-cause mortality was 12.4%. Exposure to a PPI was associated with a 55% reduced risk of mortality (adjusted hazard ratio (aHR) 0.45; 95% confidence interval (CI) 0.28–0.72). In our Cox model, increasing age (aHR 1.45; 95% CI 1.14–1.84), those with severe CDI infections (aHR 1.87; 95% CI 1.22–2.88), and those with hospital acquired CDI (aHR 3.01; 95% CI 1.81–4.99) also had increased 180 day mortality risk. There were similar associations noted with both 90 day and 1-year mortality. Conclusion Use of PPIs during CDI treatment in elderly patients is associated with decreased 180-day mortality. Although use of PPIs has been associated with an increased risk of CDI, it appears to be protective against mortality when used during the treatment phase.http://link.springer.com/article/10.1186/s13099-019-0309-6Clostridium difficileEnteric pathogensInfectious diseaseMedication safetyProton pump inhibitors |
| spellingShingle | Evan Stuart Bradley Emily Howe Xun Wu John P. Haran Proton pump inhibitors and 180-day mortality in the elderly after Clostridium difficile treatment Gut Pathogens Clostridium difficile Enteric pathogens Infectious disease Medication safety Proton pump inhibitors |
| title | Proton pump inhibitors and 180-day mortality in the elderly after Clostridium difficile treatment |
| title_full | Proton pump inhibitors and 180-day mortality in the elderly after Clostridium difficile treatment |
| title_fullStr | Proton pump inhibitors and 180-day mortality in the elderly after Clostridium difficile treatment |
| title_full_unstemmed | Proton pump inhibitors and 180-day mortality in the elderly after Clostridium difficile treatment |
| title_short | Proton pump inhibitors and 180-day mortality in the elderly after Clostridium difficile treatment |
| title_sort | proton pump inhibitors and 180 day mortality in the elderly after clostridium difficile treatment |
| topic | Clostridium difficile Enteric pathogens Infectious disease Medication safety Proton pump inhibitors |
| url | http://link.springer.com/article/10.1186/s13099-019-0309-6 |
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