Association between proton pump inhibitor therapy and clostridium difficile infection: a contemporary systematic review and meta-analysis.
<h4>Introduction</h4>Emerging epidemiological evidence suggests that proton pump inhibitor (PPI) acid-suppression therapy is associated with an increased risk of Clostridium difficile infection (CDI).<h4>Methods</h4>Ovid MEDLINE, EMBASE, ISI Web of Science, and Scopus were se...
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2012
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oai:doaj.org-article:240467569afd4831827d4903ae04fcde2021-11-18T08:06:03ZAssociation between proton pump inhibitor therapy and clostridium difficile infection: a contemporary systematic review and meta-analysis.1932-620310.1371/journal.pone.0050836https://doaj.org/article/240467569afd4831827d4903ae04fcde2012-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/23236397/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Introduction</h4>Emerging epidemiological evidence suggests that proton pump inhibitor (PPI) acid-suppression therapy is associated with an increased risk of Clostridium difficile infection (CDI).<h4>Methods</h4>Ovid MEDLINE, EMBASE, ISI Web of Science, and Scopus were searched from 1990 to January 2012 for analytical studies that reported an adjusted effect estimate of the association between PPI use and CDI. We performed random-effect meta-analyses. We used the GRADE framework to interpret the findings.<h4>Results</h4>We identified 47 eligible citations (37 case-control and 14 cohort studies) with corresponding 51 effect estimates. The pooled OR was 1.65, 95% CI (1.47, 1.85), I(2) = 89.9%, with evidence of publication bias suggested by a contour funnel plot. A novel regression based method was used to adjust for publication bias and resulted in an adjusted pooled OR of 1.51 (95% CI, 1.26-1.83). In a speculative analysis that assumes that this association is based on causality, and based on published baseline CDI incidence, the risk of CDI would be very low in the general population taking PPIs with an estimated NNH of 3925 at 1 year.<h4>Conclusions</h4>In this rigorously conducted systemic review and meta-analysis, we found very low quality evidence (GRADE class) for an association between PPI use and CDI that does not support a cause-effect relationship.Imad M TleyjehAref A Bin AbdulhakMuhammad RiazFaisal A AlasmariMusa A GarbatiMushabab AlGhamdiAbdur Rahman KhanMohamad Al TannirPatricia J ErwinTalal IbrahimAbed AllehibiLarry M BaddourAlex J SuttonPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 7, Iss 12, p e50836 (2012) |
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Medicine R Science Q Imad M Tleyjeh Aref A Bin Abdulhak Muhammad Riaz Faisal A Alasmari Musa A Garbati Mushabab AlGhamdi Abdur Rahman Khan Mohamad Al Tannir Patricia J Erwin Talal Ibrahim Abed Allehibi Larry M Baddour Alex J Sutton Association between proton pump inhibitor therapy and clostridium difficile infection: a contemporary systematic review and meta-analysis. |
| description |
<h4>Introduction</h4>Emerging epidemiological evidence suggests that proton pump inhibitor (PPI) acid-suppression therapy is associated with an increased risk of Clostridium difficile infection (CDI).<h4>Methods</h4>Ovid MEDLINE, EMBASE, ISI Web of Science, and Scopus were searched from 1990 to January 2012 for analytical studies that reported an adjusted effect estimate of the association between PPI use and CDI. We performed random-effect meta-analyses. We used the GRADE framework to interpret the findings.<h4>Results</h4>We identified 47 eligible citations (37 case-control and 14 cohort studies) with corresponding 51 effect estimates. The pooled OR was 1.65, 95% CI (1.47, 1.85), I(2) = 89.9%, with evidence of publication bias suggested by a contour funnel plot. A novel regression based method was used to adjust for publication bias and resulted in an adjusted pooled OR of 1.51 (95% CI, 1.26-1.83). In a speculative analysis that assumes that this association is based on causality, and based on published baseline CDI incidence, the risk of CDI would be very low in the general population taking PPIs with an estimated NNH of 3925 at 1 year.<h4>Conclusions</h4>In this rigorously conducted systemic review and meta-analysis, we found very low quality evidence (GRADE class) for an association between PPI use and CDI that does not support a cause-effect relationship. |
| format |
article |
| author |
Imad M Tleyjeh Aref A Bin Abdulhak Muhammad Riaz Faisal A Alasmari Musa A Garbati Mushabab AlGhamdi Abdur Rahman Khan Mohamad Al Tannir Patricia J Erwin Talal Ibrahim Abed Allehibi Larry M Baddour Alex J Sutton |
| author_facet |
Imad M Tleyjeh Aref A Bin Abdulhak Muhammad Riaz Faisal A Alasmari Musa A Garbati Mushabab AlGhamdi Abdur Rahman Khan Mohamad Al Tannir Patricia J Erwin Talal Ibrahim Abed Allehibi Larry M Baddour Alex J Sutton |
| author_sort |
Imad M Tleyjeh |
| title |
Association between proton pump inhibitor therapy and clostridium difficile infection: a contemporary systematic review and meta-analysis. |
| title_short |
Association between proton pump inhibitor therapy and clostridium difficile infection: a contemporary systematic review and meta-analysis. |
| title_full |
Association between proton pump inhibitor therapy and clostridium difficile infection: a contemporary systematic review and meta-analysis. |
| title_fullStr |
Association between proton pump inhibitor therapy and clostridium difficile infection: a contemporary systematic review and meta-analysis. |
| title_full_unstemmed |
Association between proton pump inhibitor therapy and clostridium difficile infection: a contemporary systematic review and meta-analysis. |
| title_sort |
association between proton pump inhibitor therapy and clostridium difficile infection: a contemporary systematic review and meta-analysis. |
| publisher |
Public Library of Science (PLoS) |
| publishDate |
2012 |
| url |
https://doaj.org/article/240467569afd4831827d4903ae04fcde |
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