Association between Proton Pump Inhibitor Use and CNS Infection Risk: A Retrospective Cohort Study.

Wei-Te Hung,Chao-Bin Yeh,Chi-Ho Chan,Ying-Tung Yeh,Yu-Hsun Wang,Shun-Fa Yang,Ming-Yung Chou,Han-Wei Yeh,Ying-Hock Teng,Ming-Chih Chou

doi:10.3390/jcm7090252

Abstract

This study investigated the incidence of central nervous system (CNS) infection following the use of proton pump inhibitors (PPIs). A retrospective cohort study was conducted in Taiwan by using data from the National Health Insurance Research Database. We identified and enrolled 16,241 patients with CNS infection who used PPIs (PPI users). The patients were individually propensity score matched (1:1) according to age, sex, hypertension, hyperlipidemia, Charlson comorbidity index (CCI), H2 blocker, non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroid, and immunosuppressant use with 16,241 controls (PPI nonusers). A Cox proportional hazards model was used to estimate adjusted hazard ratio (aHR) for CNS infection in the PPI users and nonusers. After adjustment for other confounding factors, the incidence of CNS infection in the PPI users was 2.23-fold higher than that in the PPI nonusers (95% CI = 1.27–3.94). In addition, the PPI users exhibited a higher risk of CNS infection than the nonusers in the hypertension and CCI = 1 groups (aHR = 3.80, 95% CI = 1.40–10.32; aHR = 2.47, 95% CI = 1.07–5.70 in the PPI users and nonusers, respectively). In conclusions, according to these results, we concluded that the incidence of CNS infection was higher in the PPI users than in the nonusers.

Highlights

Proton pump inhibitors (PPIs) have been clinically used for nearly three decades for treating patients of all ages [1,2]
The PPI nonuser group comprised patients who did not use PPIs from 2009 to 2013. For both groups to have the same starting date, initially, a 1:10 ratio was used for age and sex matching while establishing an index date for the PPI nonuser group that corresponded to the index date of the PPI user group
A 1:10 ratio was used for age and sex matching while establishing an index date for the PPI nonuser group that corresponded to the index date of the PPI user group

Summary

Introduction

Proton pump inhibitors (PPIs) have been clinically used for nearly three decades for treating patients of all ages [1,2]. PPIs are a family of structurally related prodrugs that inhibit the H+/K+-ATPase enzyme in parietal cells by covalently binding to the cysteine residue of the enzyme [3,5]. In addition to their action in the stomach, PPIs were recently reported to inhibit proton pumps for maintaining the pH level in the pancreas [6]. Noninfectious factors such as age, occupation, immune status, sexual behavior, and drug abuse are key factors that increase the risk of CNS infection [18]. We hypothesized that PPI users are at a higher risk of CNS infection than are PPI nonusers

Methods

Results

Conclusion