EXAMINING RISK OF C DIFFICILE INFECTION WITH USE OF PROTON PUMP INHIBITOR VS H2 RECEPTOR ANTAGONIST

Abstract

SESSION TITLE: Miscellaneous Critical Care SESSION TYPE: Original Investigations PRESENTED ON: 10/10/2018 07:30 AM - 08:30 AM PURPOSE: Clostridium difficile is a spore forming gram positive anaerobic bacteria that colonizes the large intestine and can cause colitis in susceptible populations, especially those with recent antibiotic use. Antibiotic therapy commonly leads to C. difficile infection (CDI) by alteration of the normal gut flora. More recently, usage of proton pump inhibitors (PPIs) have been shown to play a considerable role in this process as well. Studies have shown lower risks in H2 receptor antagonists (H2RAs) in comparison, however up to 73% of acid suppressant therapies (AST) have been found to be unnecessary in the hospital. We undertook a retrospective observational study to look at the prevalence of H2RA and PPI use in a patient population with confirmed laboratory diagnosis of CDI. METHODS: Hospital databases were accessed from January 1, 2014 to June 30, 2017 using the hospital Vigilanz software. Patients with a positive C. difficile toxin test, performed greater than or equal to 3 days after initial hospital admission, were defined as HA-CDI. Those with positive test performed prior to the 3 day mark were considered community acquired and excluded from the study. Rates of positive C. difficile toxin tests for each group were calculated. RESULTS: The study found 125 CDI cases confirmed by laboratory analysis. The average age of patients with CDI was 65 years, the study group consisted of 63/125 (50.4%) males and 62/125 (49.6%) females. 108/125 (86.4%) of patients were on AST. 81/108 (75%) of those on AST were taking H2RAs, of which 46/81 (56.8%) were on H2RA monotherapy. 63/108 (58.33%) of patients on AST were taking PPIs, of which 28/63 (44.44%) were on PPI monotherapy. Of the 74 patients with CDI who either taking H2RA or PPI, 46/74 (62.16%) were on H2RA therapy and 28/74 (37.84%) were on PPI therapy. Incidence of CDI with H2RA therapy was higher than with PPI therapy; this was not statistically significant (p =0.112). CONCLUSIONS: Studies have suggested that incidence of CDI is higher among patients who are on PPI as compared to those on H2RA. Our study failed to show this difference. Our preliminary study has several limitations as a small retrospective study with limited duration. Antibiotic regimen were also not taken into consideration. However, this study does hold value in providing feasibility for larger future studies. 32% of the patients with CDI were on both therapies at one point during the study period. Thus, a study may be undertaken in order to compare rates of CDI between PPI versus those de-escalated to H2RA from PPI, given a larger sample size is available. Furthermore, the role of de-escalation of both antibiotics and AST in decreasing the risk of CDI should also be explored. CLINICAL IMPLICATIONS: Unnecessary overuse of AST among hospitalized patients should be avoided. DISCLOSURES: No relevant relationships by Janay Bailey, source=Web Response No relevant relationships by Harmeet Deol, source=Web Response No relevant relationships by Mathew Kalapurayil, source=Web Response No relevant relationships by Alok Shrestha, source=Web Response No relevant relationships by Raghujit Singh, source=Web Response Speaker/Speaker's Bureau relationship with Sunovian Please note: $5001 - $20000 Added 11/20/2017 by Salim Surani, source=Web Response, value=Honoraria Advisory Committee Member relationship with Astra Zeneca Please note: $5001 - $20000 Added 11/20/2017 by Salim Surani, source=Web Response, value=Consulting fee