Cao F, et al. – An updated meta–analysis of controlled observational studies was performed to assess link between Clostridium difficile infection (CDI) and proton–pump inhibitors (PPIs). Findings revealed a significant associated risk of incident CDI among PPI users, especially in general ward patients. The totality of evidence showed that further trials are unlikely to overturn this positive result. Therefore they recommended establishing a guideline for the use of PPI to help in the future with the control of CDI.

Methods

• The literature from their inception to December 2016 was searched without restriction of language.
• All controlled observational studies examining the association between acid suppressive therapy and CDI were included.

Results

• Pooled analysis of 50 studies revealed marked link between PPI use and risk of developing CDI, OR 1.26, (1.12–1.39) as compared with non–users.
• The relative risk of hospital–acquired CDI and community–associated CDI were 1.29(1.14–1.44) and 1.17(0.74–1.59).
• In accordance to hospital department, the relative risks of hospital–acquired CDI in ICUs and general wards were 1.43(0.74–2.11) and 1.29(1.13–1.45).
• Cumulative meta–analysis clarified that earlier trials of CDI conducted in the early 2000s demonstrated a high degree of heterogeneity and a high percentage of negative results.
• Since 2011, relatively stable association between PPI use and risk of developing CDI has been observed within an effect size between OR 1.20 and 1.26.