Inappropriate Use of Gastric Acid Suppression Therapy in Hospitalized Patients with Clostridium difficile—Associated Diarrhea: A Ten-Year Retrospective Analysis

Sadat Rashid,Paul Mustacchia,Valeria Zilberman,Dhyan Rajan,Seth Lipka,Javed Iqbal,Mitanshu Shah,Robin Jacob

doi:10.5402/2012/902320

Sadat Rashid, Paul Mustacchia + Show 6 more

Open Access

https://doi.org/10.5402/2012/902320

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Journal: ISRN Gastroenterology	Publication Date: May 31, 2012
Citations: 17	License type: CC BY 3.0

Affiliation: Nassau University Medical Center

Abstract

Purpose. The incidence of Clostridium difficile-associated diarrhea (CDAD) has steadily increased over the past decade. A multitude of factors for this rise in incidence of CDAD have been postulated, including the increased use of gastric acid suppression therapy (GAST). Despite the presence of practice guidelines for use of GAST, studies have demonstrated widespread inappropriate use of GAST in hospitalized patients. We performed a retrospective analysis of inpatients with CDAD, with special emphasis placed on determining the appropriateness of GAST. Methods. A retrospective analysis was conducted at a multidisciplinary teaching hospital on inpatients with CDAD over a 10-year period. We assessed the use of GAST in the cases of CDAD. Data collection focused on the appropriate administration of GAST as defined by standard practice guidelines. Results. An inappropriate indication for GAST was not apparent in a majority (69.4%) of patients with CDAD. The inappropriate use of GAST was more prevalent in medical (86.1%) than on surgical services (13.9%) (P < 0.001). There were more cases (67.6%) of inappropriate use of GAST in noncritical care than in critical care areas (37.4%) (P < 0.001). Conclusion. Our study found that an inappropriate use of inpatient GAST in patients with CDAD was nearly 70 percent. Reduction of inappropriate use of GAST may be an additional approach to reduce the risk of CDAD and significantly decrease patient morbidity and healthcare costs.

Highlights

Clostridium difficile (C. difficile), a Gram-positive, sporulating, anaerobic bacterium, is the most common cause of nosocomial diarrhea in the United States [1]
An association between gastric acid suppression therapy (GAST) and C. difficile-associated diarrhea (CDAD) has been proposed in prior studies [1,2,3, 6, 15,16,17,18]
Our study was designed to assess the appropriateness of GAST in patients who developed CDAD

Summary

Introduction

Clostridium difficile (C. difficile), a Gram-positive, sporulating, anaerobic bacterium, is the most common cause of nosocomial diarrhea in the United States [1]. The reported cases of C. difficile-associated diarrhea (CDAD) have steadily increased over the past decade, with a reported incidence of 0.1–2% in all hospitalized patients [1]. Review of literature suggests that the use of gastric acid suppression therapy (GAST) is associated with increasing incidence of CDAD [1,2,3]. A suggested mechanism for this association is believed to be the increase in gastric pH secondary to GAST, allowing for the survival of the C. difficile bacteria and spores [1]. Gastric acid suppression is commonly achieved with the use of proton pump inhibitors (PPIs) and histamine-2 receptor antagonists (H2As). An appropriate indication for the use of GAST is often present, inappropriate use of such therapy is frequently observed in an inpatient setting, possibly resulting in an increased incidence of nosocomial CDAD [1, 4, 6]

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Results

Conclusion