Exposure to Gastric Acid-Suppression Therapy Is Associated With Health Care- and Community-Associated Clostridium difficile Infection in Children.

Abstract

OBJECTIVE:

The aim of the study was to determine whether gastric acid-suppression therapy is associated with Clostridium difficile infection (CDI) in both inpatient and outpatient pediatric populations.

METHODS:

We conducted a retrospective case-control study at a 200-bed academic pediatric hospital and associated outpatient clinics during 2005-2010. We defined cases as children 1 to 18 years of age with a first positive test for C difficile toxin A/B, and matched each case to 2 controls without C difficile. We conducted chart review to elicit selected comorbidities and exposure to gastric acid-suppression therapy and antibiotics in the preceding 3 months of the infection or encounter date. We used bivariate and multivariable logistic regression to evaluate the association between antacid use and CDI, controlling for potential confounders.

RESULTS:

We identified 138 children with health care- or community-associated CDIs and 276 controls. The use of any acid suppression therapy was more common in cases compared with controls (34% vs 20%, P = 0.002). When adjusted for demographic variables and comorbidities, gastric acid-suppression therapy remained significantly associated with CDI (adjusted odds ratio [aOR] 1.8, 95% confidence interval [CI] 1.0-3.1). Antibiotic use (aOR 1.7, 95% CI 1.1-2.7) and immunosuppressed state were also associated with CDI in our adjusted model (aOR 2.5, 95% CI 1.2-5.2).

CONCLUSIONS:

Gastric acid-suppression therapy was associated with both health care- and community-associated CDIs in children. Larger pediatric studies are necessary to determine the role of proton pump inhibitors specifically in causing CDI in children.

• Authors: Jennifer Jimenez, Marci Drees, Beth Loveridge-Lenza, Stephen Eppes, Fernando delRosario
• Journal: Journal of pediatric gastroenterology and nutrition (J Pediatr Gastroenterol Nutr) Vol. 61 Issue 2 Pg. 208-11 (Aug 2015) ISSN: 1536-4801 [Electronic] United States
• PMID: 25806678 (Publication Type: Journal Article)

Chemical References

• Antacids
• Anti-Bacterial Agents
• Proton Pump Inhibitors

Topics

• Adolescent
• Age Factors
• Antacids (adverse effects)
• Anti-Bacterial Agents (adverse effects)
• Black People
• Case-Control Studies
• Child
• Child, Preschool
• Clostridioides difficile (isolation & purification)
• Enterocolitis, Pseudomembranous (chemically induced, epidemiology)
• Gastric Acid
• Humans
• Infant
• Inpatients
• Odds Ratio
• Outpatients
• Proton Pump Inhibitors (adverse effects)
• Retrospective Studies
• Risk Factors
• Tertiary Care Centers
• United States (epidemiology)
• White People