(273) Risk of Clostridium Difficile Infection Associated with Used of Proton Pump Inhibitors and Histamine-2 Receptor Antagonists in Taiwan Hospitalized Patients

Friday, August 26, 2022

8:00 AM – 6:00 PM CEST

Location: Hall C

Publication Number: 604

Presenting Author(s)

Yi Hsuan Liu
– NCKU Institute of Clinical Pharmacy and Pharmaceutical Sciences

Co-Author(s)

Yea-Huei Kao Yang, RPh, FISPE
– Professor, NCKU Institute of Clinical Pharmacy and Pharmaceutical Sciences, Tainan, Taiwan (Republic of China)
Lu Hsuan Wu, PhD
– Post Dr. researcher, NCKU Institute of Clinical Pharmacy and Pharmaceutical Sciences, Tainan, Tainan, Taiwan (Republic of China)
Chien-Chou Su
– Data Scientist, Clinical Innovation and Research Center, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan., Tainan, Taiwan (Republic of China)

Background: Clostridium difficile infection (CDI), which could cause life-threatening pseudomembranous colitis, has become one of the most important nosocomial infections. So far, numerous studies have shown that proton pump inhibitors (PPIs) and histamine-2 receptor antagonists (H2RAs) played a considerable role as well. At present, PPIs and H2RAs are frequently prescribed to hospitalized patients for stress ulcer prophylaxis (SUP). However, the head-to-head comparative risk of CDI between PPIs and H2RAs remains unclear.

Objectives: To compare the risk of CDI in Taiwan hospitalized patients who exposed to PPIs and H2RAs for SUP between 2017 to 2018.

Methods: We conducted a retrospective cohort study by using the National Health Insurance Database (NHID) to identify hospitalized patients aged above 20 years old who used PPIs or H2RAs during hospitalization between 2017 to 2018. Patients with records of PPIs or H2RAs 180 days before index date or history of gastrointestinal ulcer 180 days prior to admission date were excluded. Eligible patients were then grouped according to their first prescriptions and followed at most 90 days from the admission date. The date of their first prescription of PPIs or H2RAs was defined as the index date. Patients were censored when the occurrence of CDI, discontinuation, switch, death, or end of observation, whichever came first. CDI was defined as having prescription of metronidazole, fidaxomicin, and oral vancomycin over 7 days plus either the records of C.difficle toxin test or CDI diagnosis (ICD-9=008.45, ICD-10=A04.7). Cox proportional hazards model was used to compare the risk of CDI between two groups, and the results were presented as adjusted hazard ratios and 95% confidence intervals.

Results: A total of 406,926 patients were identified, 49.3% used PPIs and 50.7% used H2RAs. Both groups had mean age around 67 years old and similar length of hospitalization about 17 days [mean 17.6 (SD 14.8), 16.1(SD 13.8)]. Incidence of CDI were higher among patients in PPIs than those in H2RAs (3.8 vs 3.1 per 10,000 patents-days), and risk of CDI in PPIs group was significantly higher than H2RAs group (HR, 1.16; 95%CI, 1.02–1.33). To consolidate the outcome measurement, we extended the prescription of CDI treatment from 7 days to 10 days as sensitivity analysis, and the comparable result confirms the robustness of the result.

Conclusions: In Taiwan hospitalized patients who used PPIs for SUP have higher incidence rate of CDI than that of H2RAs. It is important for clinicians to be aware of the risk of CDI in patients who used PPIs and H2RAs and evaluate the necessity of SUP in hospitalized patients.