The Effect of Proton Pump Inhibitors on the Prevalence of Clostridium difficile Infection Público

Kundu, Abir Amory (2011)

Permanent URL: https://etd.library.emory.edu/concern/etds/3r074v63q?locale=pt-BR
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Abstract

The Effect of Proton Pump Inhibitors on the Prevalence of Clostridium difficile Infection


By Abir Kundu


Clostridium difficile infection is an increasing problem in hospitals across the United States. Proton pump inhibitors (PPIs) have been implicated in many studies as a possible risk factor for Clostridium difficile infections. This study examines the prevalence of Clostridium difficile infections amongst the veteran population at the VA Hospital in New Haven, CT and whether the use of PPIs increases the chance for infection. The study was a retrospective cohort study with all unique admissions between fiscal years 2003 and 2007 being considered. Variables of interest in the study include: PPI use, age, race, hospital location, fluoroquinolone use, gender, length of stay, and intravenous vancomycin use. Odds ratios and corresponding confidence intervals were calculated in order to provide a measure of comparison. P-values were calculated from a logistic regression model that included all variables of interest. A final predictive model was created using backwards selection. What the study determined was PPI usage did not increase the chance of acquiring Clostridium difficile infection (p=0.2752). However, the study subject's length of stay in the hospital (p<0.0001) and fluoroquinolone use (OR: 2.29, 95% CI: 1.44-3.65) were found to be the most statistically significant factors in predicting the chance of a patient acquiring Clostridium difficile infection during the duration of the study period. In conclusion, the study suggests that there is no correlation between proton pump inhibitor use and the acquiring of a Clostridium difficile infection. However, the longer a patient resides in the hospital setting, the higher the chance that the patient will develop a Clostridium difficile infection. Also, the use of antibiotics such as fluoroquinolones increases the odds of developing the Clostridium difficile infection as well. Further studies should be conducted in order to determine what other consistent risk factors there are for Clostridium difficile infections.

Table of Contents

TABLE OF CONTENTS


Page


1. Introduction……………………………………………………………………….1


2. Literature Review


2.1 Background.……………………………………………………………...4


2.2 Pathogenicity……………………………………………………………..4


2.3 Diagnosis….……………………………………………………………...5


2.4 Prevention…………………………………………………………….......6


2.5 Proton Pump Inhibitors ...………………...……………………………...6


3. Methods…………………………………………………………………………..12


4. Results……………………………………………………………………………18


4.1 Modeling.…………………………………………………………….....19


4.2 Gender…………………………………………………………………..19


4.3 Race….…………………………………………………………….........20


4.4 Hospital Location ….……………………………………………….......21


4.5 Length of Stay ………...………………...……………………………...21


4.6 Proton Pump Inhibitors .………………...……………………………...22


4.7 Other Variables………...………………...……………………………...23


5. Discussion…………………………………………………………………………25


6. References…………………………………………………………………………30


7. Appendix………………………………………………………………..…………33



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