Comparison of the hospital-acquired clostridium difficile infection risk of using proton pump inhibitors versus histamine-2 receptor antagonists for prophylaxis and treatment of stress ulcers: A systematic review and meta-analysis

Mohamed Azab, Loomee Doo, Daniel H. Doo, Yousif Elmofti, Muazer Ahmed, John Jay Cadavona, Xibei B. Liu, Amaan Shafi, Moon Kyung Joo, Ji Won Yoo

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Background/Aims: Although proton pump inhibitors (PPIs) have been widely used for the prevention and treatment of stress gastric ulcers in hospital settings, there are concerns that PPIs increase the risk of Clostridium difficile infection (CDI). However, little is known about the risk of CDI following PPI and histamine-2 receptor antagonist (H2RA) use. We evaluated the comparative hospital-acquired CDI occurrence risk associated with the concurrent use of PPIs versus H2RAs. Methods: A systematic search of PubMed, MEDLINE/Ovid, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, and Google Scholar through August 19, 2016, identified 12 studies that reported the hospital-acquired CDI occurrence following H2RA and PPI use for the prevention and treatment of stress gastric ulcers. Random-effects pooled odds ratios and 95% confidence intervals were estimated. Heterogeneity was measured using I2, and a meta-regression analysis was conducted. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system was used to assess the overall quality of the evidence. Results: A total of 74,132 patients from 12 observational studies were analyzed. Compared to H2RAs, PPIs increased the risk of CDI by 38.6% (pooled odds ratio, 1.386; 95% confidence interval, 1.152 to 1.668; p=0.001; I2=42.81%). Subgroup analyses of the purpose of study medication use, study site, and study design confirmed the consistency of a greater CDI risk with PPIs than with H2RAs. The overall quality of evidence was rated as low. Conclusions: The use of PPIs for both the prevention and treatment of stress ulcers was associated with a 38.6% increased risk of hospital-acquired CDI occurrence compared to H2RA use.

Original languageEnglish
Pages (from-to)781-788
Number of pages8
JournalGut and Liver
Volume11
Issue number6
DOIs
Publication statusPublished - 2017 Nov 1

Fingerprint

Clostridium Infections
Histamine Receptors
Clostridium difficile
Proton Pump Inhibitors
Ulcer
Meta-Analysis
Stomach Ulcer
Therapeutics
Odds Ratio
Confidence Intervals
PubMed
MEDLINE
Observational Studies
Nursing
Regression Analysis
Health

Keywords

  • Clostridium
  • Histamine antagonists
  • Meta-analysis
  • Proton pump inhibitors
  • Stomach ulcer

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

Cite this

Comparison of the hospital-acquired clostridium difficile infection risk of using proton pump inhibitors versus histamine-2 receptor antagonists for prophylaxis and treatment of stress ulcers : A systematic review and meta-analysis. / Azab, Mohamed; Doo, Loomee; Doo, Daniel H.; Elmofti, Yousif; Ahmed, Muazer; Cadavona, John Jay; Liu, Xibei B.; Shafi, Amaan; Joo, Moon Kyung; Yoo, Ji Won.

In: Gut and Liver, Vol. 11, No. 6, 01.11.2017, p. 781-788.

Research output: Contribution to journalArticle

Azab, Mohamed ; Doo, Loomee ; Doo, Daniel H. ; Elmofti, Yousif ; Ahmed, Muazer ; Cadavona, John Jay ; Liu, Xibei B. ; Shafi, Amaan ; Joo, Moon Kyung ; Yoo, Ji Won. / Comparison of the hospital-acquired clostridium difficile infection risk of using proton pump inhibitors versus histamine-2 receptor antagonists for prophylaxis and treatment of stress ulcers : A systematic review and meta-analysis. In: Gut and Liver. 2017 ; Vol. 11, No. 6. pp. 781-788.
@article{16360292107d4c6a8820fdccd5daa9d6,
title = "Comparison of the hospital-acquired clostridium difficile infection risk of using proton pump inhibitors versus histamine-2 receptor antagonists for prophylaxis and treatment of stress ulcers: A systematic review and meta-analysis",
abstract = "Background/Aims: Although proton pump inhibitors (PPIs) have been widely used for the prevention and treatment of stress gastric ulcers in hospital settings, there are concerns that PPIs increase the risk of Clostridium difficile infection (CDI). However, little is known about the risk of CDI following PPI and histamine-2 receptor antagonist (H2RA) use. We evaluated the comparative hospital-acquired CDI occurrence risk associated with the concurrent use of PPIs versus H2RAs. Methods: A systematic search of PubMed, MEDLINE/Ovid, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, and Google Scholar through August 19, 2016, identified 12 studies that reported the hospital-acquired CDI occurrence following H2RA and PPI use for the prevention and treatment of stress gastric ulcers. Random-effects pooled odds ratios and 95{\%} confidence intervals were estimated. Heterogeneity was measured using I2, and a meta-regression analysis was conducted. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system was used to assess the overall quality of the evidence. Results: A total of 74,132 patients from 12 observational studies were analyzed. Compared to H2RAs, PPIs increased the risk of CDI by 38.6{\%} (pooled odds ratio, 1.386; 95{\%} confidence interval, 1.152 to 1.668; p=0.001; I2=42.81{\%}). Subgroup analyses of the purpose of study medication use, study site, and study design confirmed the consistency of a greater CDI risk with PPIs than with H2RAs. The overall quality of evidence was rated as low. Conclusions: The use of PPIs for both the prevention and treatment of stress ulcers was associated with a 38.6{\%} increased risk of hospital-acquired CDI occurrence compared to H2RA use.",
keywords = "Clostridium, Histamine antagonists, Meta-analysis, Proton pump inhibitors, Stomach ulcer",
author = "Mohamed Azab and Loomee Doo and Doo, {Daniel H.} and Yousif Elmofti and Muazer Ahmed and Cadavona, {John Jay} and Liu, {Xibei B.} and Amaan Shafi and Joo, {Moon Kyung} and Yoo, {Ji Won}",
year = "2017",
month = "11",
day = "1",
doi = "10.5009/gnl16568",
language = "English",
volume = "11",
pages = "781--788",
journal = "Gut and Liver",
issn = "1976-2283",
publisher = "Joe Bok Chung",
number = "6",

}

TY - JOUR

T1 - Comparison of the hospital-acquired clostridium difficile infection risk of using proton pump inhibitors versus histamine-2 receptor antagonists for prophylaxis and treatment of stress ulcers

T2 - A systematic review and meta-analysis

AU - Azab, Mohamed

AU - Doo, Loomee

AU - Doo, Daniel H.

AU - Elmofti, Yousif

AU - Ahmed, Muazer

AU - Cadavona, John Jay

AU - Liu, Xibei B.

AU - Shafi, Amaan

AU - Joo, Moon Kyung

AU - Yoo, Ji Won

PY - 2017/11/1

Y1 - 2017/11/1

N2 - Background/Aims: Although proton pump inhibitors (PPIs) have been widely used for the prevention and treatment of stress gastric ulcers in hospital settings, there are concerns that PPIs increase the risk of Clostridium difficile infection (CDI). However, little is known about the risk of CDI following PPI and histamine-2 receptor antagonist (H2RA) use. We evaluated the comparative hospital-acquired CDI occurrence risk associated with the concurrent use of PPIs versus H2RAs. Methods: A systematic search of PubMed, MEDLINE/Ovid, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, and Google Scholar through August 19, 2016, identified 12 studies that reported the hospital-acquired CDI occurrence following H2RA and PPI use for the prevention and treatment of stress gastric ulcers. Random-effects pooled odds ratios and 95% confidence intervals were estimated. Heterogeneity was measured using I2, and a meta-regression analysis was conducted. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system was used to assess the overall quality of the evidence. Results: A total of 74,132 patients from 12 observational studies were analyzed. Compared to H2RAs, PPIs increased the risk of CDI by 38.6% (pooled odds ratio, 1.386; 95% confidence interval, 1.152 to 1.668; p=0.001; I2=42.81%). Subgroup analyses of the purpose of study medication use, study site, and study design confirmed the consistency of a greater CDI risk with PPIs than with H2RAs. The overall quality of evidence was rated as low. Conclusions: The use of PPIs for both the prevention and treatment of stress ulcers was associated with a 38.6% increased risk of hospital-acquired CDI occurrence compared to H2RA use.

AB - Background/Aims: Although proton pump inhibitors (PPIs) have been widely used for the prevention and treatment of stress gastric ulcers in hospital settings, there are concerns that PPIs increase the risk of Clostridium difficile infection (CDI). However, little is known about the risk of CDI following PPI and histamine-2 receptor antagonist (H2RA) use. We evaluated the comparative hospital-acquired CDI occurrence risk associated with the concurrent use of PPIs versus H2RAs. Methods: A systematic search of PubMed, MEDLINE/Ovid, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, and Google Scholar through August 19, 2016, identified 12 studies that reported the hospital-acquired CDI occurrence following H2RA and PPI use for the prevention and treatment of stress gastric ulcers. Random-effects pooled odds ratios and 95% confidence intervals were estimated. Heterogeneity was measured using I2, and a meta-regression analysis was conducted. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system was used to assess the overall quality of the evidence. Results: A total of 74,132 patients from 12 observational studies were analyzed. Compared to H2RAs, PPIs increased the risk of CDI by 38.6% (pooled odds ratio, 1.386; 95% confidence interval, 1.152 to 1.668; p=0.001; I2=42.81%). Subgroup analyses of the purpose of study medication use, study site, and study design confirmed the consistency of a greater CDI risk with PPIs than with H2RAs. The overall quality of evidence was rated as low. Conclusions: The use of PPIs for both the prevention and treatment of stress ulcers was associated with a 38.6% increased risk of hospital-acquired CDI occurrence compared to H2RA use.

KW - Clostridium

KW - Histamine antagonists

KW - Meta-analysis

KW - Proton pump inhibitors

KW - Stomach ulcer

UR - http://www.scopus.com/inward/record.url?scp=85036646959&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85036646959&partnerID=8YFLogxK

U2 - 10.5009/gnl16568

DO - 10.5009/gnl16568

M3 - Article

C2 - 28506028

AN - SCOPUS:85036646959

VL - 11

SP - 781

EP - 788

JO - Gut and Liver

JF - Gut and Liver

SN - 1976-2283

IS - 6

ER -