Exposure to Gastric Acid-Suppression Therapy is Associated with Healthcare-Associated and Community-Associated C. difficile Infection in Children
Methods: To determine whether gastric acid-suppression therapy is associated with CDI in both inpatient and outpatient pediatric populations, we conducted a retrospective case-control study at a 200-bed academic pediatric hospital and associated outpatient clinics in the time frame 2005-2010. We defined cases as children 1-18 years of age with a first positive test for C. difficile toxin A/B (Meridian Bioscience) on liquid stool, 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 (including H2 blockers and PPIs) and antibiotics in the 3 months preceding 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 CDI (61% community-associated, the remainder healthcare-related or indeterminate) and 276 controls. Use of any acid suppression therapy was more common in cases compared to controls (34% vs.20%, p <0.01). 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], 1.01-3.10). Antibiotic use (aOR, 1.7; 95% CI, 1.1-2.7) and immunosuppressed state (aOR, 2.5; 95% CI, 1.2-5.2) were also associated with CDI in our adjusted model.
Conclusion: Gastric acid-suppression therapy was associated with both healthcare-associated and community-associated CDI in children. Larger pediatric studies are necessary to determine the role of PPIs specifically in causing CDI in children.
B. Loveridge-Lenza, None
S. Eppes, None
F. Delrosario, None
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