Proton pump inhibitors and the risk of hospital acquired clostridioides difficile infection in critically ill patients.

BACKGROUND

Proton pump inhibitors (PPIs) are commonly prescribed medications for critically ill patients. However, the existence of a clear association between PPI prescriptions and Clostridioides difficile infection (CDI) remains controversial. This study aims to investigate the relationship between PPI use and CDI, thereby providing additional evidence for the clinical application of PPIs.

METHODS

This study extracted data from the eICU and MIMIC IV databases, ultimately enrolling 26,090 patients. Propensity score matching was employed to balance covariates across groups. Clinical outcomes were compared using χ2 tests after matching, and specific risk factors were analyzed via multivariate logistic regression, with results presented as odds ratios and 95% confidence intervals.

RESULTS

Compared with the non-PPI group, the PPI group showed a significantly increased risk of CDI (PPI vs. No-PPI: 2.6% vs. 1.6%; OR, 1.70; 95% CI, 1.43-2.02; p < 0.001). Across all subgroups, the risk of CDI was significantly higher in the PPI group than in the non-PPI group. Obesity (BMI ≥ 30), cancer, diabetes, IBD, kidney disease, and use of high-risk antibiotics were significantly associated with increased CDI risk in patients.

CONCLUSION

Among critically ill patients, PPI recipients exhibited a significantly increased risk of CDI compared to those not using PPIs.