Proton pump inhibitors and risk of Clostridium difficile infection: a multi-country study using sequence symmetry analysis

Elizabeth E. Roughead, Esther W. Chan, Nam Kyong Choi, Jenna Griffiths, Xue Mei Jin, Joongyub Lee, Michio Kimura, Tomomi Kimura, Kiyoshi Kubota, Edward Lai, Kenneth K.C. Man, Tuan Anh Nguyen, Nobuhiro Ooba, Byung Joo Park, Tsugumichi Sato, Ju Young Shin, Tong Tong Wang, Ian C.K. Wong, Yea-Huei Kao, Nicole L. Pratt

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Objective: To determine the association between incident proton pump inhibitor (PPI) use and Clostridium difficile infections across multiple countries Method: National data covering the total population in Australia and Korea, the Canadian population over 65 years and a 3 million person random sample data set from Taiwan were assessed, as were data from a worker insurance population and a hospital inpatient/outpatient population in Japan. Sequence symmetry analysis was used to assess the association with oral vancomycin dispensing as the outcome of interest. Results: 54,957 patients were included. Positive associations were observed in Australia; adjusted sequence ratio (ASR) 2.48 (95% CI 1.90, 3.12), Korea ASR 2.15 (95%CI 2.11, 2.19), Canada ASR 1.45 (95% CI 1.16, 1.79), Japan hospital dataset ASR 3.21 (95%CI 2.12, 4.55) and Japan worker insurance dataset ASR 5.40 (95% CI 2.73, 8.75). The pooled result was ASR 2.40 (95%CI 1.88, 3.05) and 3.16 (95%CI 1.95, 5.10) when limited to Japan, Korean and Taiwan. Results did not vary by individual PPI. The temporal analysis showed effects within the first two weeks of PPI initiation. Conclusion: Our study confirms the association between PPI initiation and C. difficile infections across countries in the Asia-Pacific region.

Original languageEnglish
Pages (from-to)1589-1595
Number of pages7
JournalExpert Opinion on Drug Safety
Volume15
Issue number12
DOIs
Publication statusPublished - 2016 Dec 1

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Clostridium Infections
Clostridium difficile
Proton Pump Inhibitors
Sequence Analysis
Japan
Korea
Insurance
Taiwan
Population
Vancomycin
Canada
Inpatients
Outpatients
Datasets

All Science Journal Classification (ASJC) codes

  • Pharmacology (medical)

Cite this

Roughead, Elizabeth E. ; Chan, Esther W. ; Choi, Nam Kyong ; Griffiths, Jenna ; Jin, Xue Mei ; Lee, Joongyub ; Kimura, Michio ; Kimura, Tomomi ; Kubota, Kiyoshi ; Lai, Edward ; Man, Kenneth K.C. ; Nguyen, Tuan Anh ; Ooba, Nobuhiro ; Park, Byung Joo ; Sato, Tsugumichi ; Shin, Ju Young ; Wang, Tong Tong ; Wong, Ian C.K. ; Kao, Yea-Huei ; Pratt, Nicole L. / Proton pump inhibitors and risk of Clostridium difficile infection : a multi-country study using sequence symmetry analysis. In: Expert Opinion on Drug Safety. 2016 ; Vol. 15, No. 12. pp. 1589-1595.
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abstract = "Objective: To determine the association between incident proton pump inhibitor (PPI) use and Clostridium difficile infections across multiple countries Method: National data covering the total population in Australia and Korea, the Canadian population over 65 years and a 3 million person random sample data set from Taiwan were assessed, as were data from a worker insurance population and a hospital inpatient/outpatient population in Japan. Sequence symmetry analysis was used to assess the association with oral vancomycin dispensing as the outcome of interest. Results: 54,957 patients were included. Positive associations were observed in Australia; adjusted sequence ratio (ASR) 2.48 (95{\%} CI 1.90, 3.12), Korea ASR 2.15 (95{\%}CI 2.11, 2.19), Canada ASR 1.45 (95{\%} CI 1.16, 1.79), Japan hospital dataset ASR 3.21 (95{\%}CI 2.12, 4.55) and Japan worker insurance dataset ASR 5.40 (95{\%} CI 2.73, 8.75). The pooled result was ASR 2.40 (95{\%}CI 1.88, 3.05) and 3.16 (95{\%}CI 1.95, 5.10) when limited to Japan, Korean and Taiwan. Results did not vary by individual PPI. The temporal analysis showed effects within the first two weeks of PPI initiation. Conclusion: Our study confirms the association between PPI initiation and C. difficile infections across countries in the Asia-Pacific region.",
author = "Roughead, {Elizabeth E.} and Chan, {Esther W.} and Choi, {Nam Kyong} and Jenna Griffiths and Jin, {Xue Mei} and Joongyub Lee and Michio Kimura and Tomomi Kimura and Kiyoshi Kubota and Edward Lai and Man, {Kenneth K.C.} and Nguyen, {Tuan Anh} and Nobuhiro Ooba and Park, {Byung Joo} and Tsugumichi Sato and Shin, {Ju Young} and Wang, {Tong Tong} and Wong, {Ian C.K.} and Yea-Huei Kao and Pratt, {Nicole L.}",
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Roughead, EE, Chan, EW, Choi, NK, Griffiths, J, Jin, XM, Lee, J, Kimura, M, Kimura, T, Kubota, K, Lai, E, Man, KKC, Nguyen, TA, Ooba, N, Park, BJ, Sato, T, Shin, JY, Wang, TT, Wong, ICK, Kao, Y-H & Pratt, NL 2016, 'Proton pump inhibitors and risk of Clostridium difficile infection: a multi-country study using sequence symmetry analysis', Expert Opinion on Drug Safety, vol. 15, no. 12, pp. 1589-1595. https://doi.org/10.1080/14740338.2016.1238071

Proton pump inhibitors and risk of Clostridium difficile infection : a multi-country study using sequence symmetry analysis. / Roughead, Elizabeth E.; Chan, Esther W.; Choi, Nam Kyong; Griffiths, Jenna; Jin, Xue Mei; Lee, Joongyub; Kimura, Michio; Kimura, Tomomi; Kubota, Kiyoshi; Lai, Edward; Man, Kenneth K.C.; Nguyen, Tuan Anh; Ooba, Nobuhiro; Park, Byung Joo; Sato, Tsugumichi; Shin, Ju Young; Wang, Tong Tong; Wong, Ian C.K.; Kao, Yea-Huei; Pratt, Nicole L.

In: Expert Opinion on Drug Safety, Vol. 15, No. 12, 01.12.2016, p. 1589-1595.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Proton pump inhibitors and risk of Clostridium difficile infection

T2 - a multi-country study using sequence symmetry analysis

AU - Roughead, Elizabeth E.

AU - Chan, Esther W.

AU - Choi, Nam Kyong

AU - Griffiths, Jenna

AU - Jin, Xue Mei

AU - Lee, Joongyub

AU - Kimura, Michio

AU - Kimura, Tomomi

AU - Kubota, Kiyoshi

AU - Lai, Edward

AU - Man, Kenneth K.C.

AU - Nguyen, Tuan Anh

AU - Ooba, Nobuhiro

AU - Park, Byung Joo

AU - Sato, Tsugumichi

AU - Shin, Ju Young

AU - Wang, Tong Tong

AU - Wong, Ian C.K.

AU - Kao, Yea-Huei

AU - Pratt, Nicole L.

PY - 2016/12/1

Y1 - 2016/12/1

N2 - Objective: To determine the association between incident proton pump inhibitor (PPI) use and Clostridium difficile infections across multiple countries Method: National data covering the total population in Australia and Korea, the Canadian population over 65 years and a 3 million person random sample data set from Taiwan were assessed, as were data from a worker insurance population and a hospital inpatient/outpatient population in Japan. Sequence symmetry analysis was used to assess the association with oral vancomycin dispensing as the outcome of interest. Results: 54,957 patients were included. Positive associations were observed in Australia; adjusted sequence ratio (ASR) 2.48 (95% CI 1.90, 3.12), Korea ASR 2.15 (95%CI 2.11, 2.19), Canada ASR 1.45 (95% CI 1.16, 1.79), Japan hospital dataset ASR 3.21 (95%CI 2.12, 4.55) and Japan worker insurance dataset ASR 5.40 (95% CI 2.73, 8.75). The pooled result was ASR 2.40 (95%CI 1.88, 3.05) and 3.16 (95%CI 1.95, 5.10) when limited to Japan, Korean and Taiwan. Results did not vary by individual PPI. The temporal analysis showed effects within the first two weeks of PPI initiation. Conclusion: Our study confirms the association between PPI initiation and C. difficile infections across countries in the Asia-Pacific region.

AB - Objective: To determine the association between incident proton pump inhibitor (PPI) use and Clostridium difficile infections across multiple countries Method: National data covering the total population in Australia and Korea, the Canadian population over 65 years and a 3 million person random sample data set from Taiwan were assessed, as were data from a worker insurance population and a hospital inpatient/outpatient population in Japan. Sequence symmetry analysis was used to assess the association with oral vancomycin dispensing as the outcome of interest. Results: 54,957 patients were included. Positive associations were observed in Australia; adjusted sequence ratio (ASR) 2.48 (95% CI 1.90, 3.12), Korea ASR 2.15 (95%CI 2.11, 2.19), Canada ASR 1.45 (95% CI 1.16, 1.79), Japan hospital dataset ASR 3.21 (95%CI 2.12, 4.55) and Japan worker insurance dataset ASR 5.40 (95% CI 2.73, 8.75). The pooled result was ASR 2.40 (95%CI 1.88, 3.05) and 3.16 (95%CI 1.95, 5.10) when limited to Japan, Korean and Taiwan. Results did not vary by individual PPI. The temporal analysis showed effects within the first two weeks of PPI initiation. Conclusion: Our study confirms the association between PPI initiation and C. difficile infections across countries in the Asia-Pacific region.

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