PPI use increases risk of recurrent Clostridioides difficile infection
Clostridioides difficile infection (CDI) is associated with significant morbidity and mortality. Recurrent CDI is common, with between 20% to 35% of patients developing at least one recurrence after their initial diagnosis. In a recent study, researchers have found significantly higher odds of recurrent CDI among users of PPIs that persisted across multiple sensitivity analyses. The study findings were published in the journal Clinical Microbiology and Infection on 16 January 2021.
PPIs are frequently over-prescribed, and at least 50% of acid suppression medications (including H2RAs and PPIs) may be medically unnecessary. Increasing data suggest that iatrogenic gastric acid suppression is a potentially modifiable risk factor for recurrent CDI. Previous meta-analyses have evaluated the association between PPIs and recurrent CDI, however, these studies have their own limitations. Due to these limitations, and citing a lack of randomized trials, guidelines such as the Infectious Diseases Society of America (IDSA) state there is insufficient evidence for discontinuation of PPIs in patients with primary CDI as a measure for preventing recurrence and, consequently, provide no recommendation in this setting. To fill the knowledge gap researchers of America, conducted a study to evaluate the association between PPI use and recurrent CDI addressing prior methodologic limitations.
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