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Proton Pump Inhibitors and Infection-Related Hospitalizations Among Residents of Long-Term Care Facilities: A Case–Control Study

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Abstract

Objective

Our objective was to investigate associations between proton pump inhibitor (PPIs) use and infection-related hospitalizations among residents of long-term care facilities (LTCFs).

Methods

This was a case–control study of residents aged ≥ 65 years admitted to hospital between July 2013 and June 2015. Residents admitted for infections (cases) and falls or fall-related injuries (controls) were matched for age (± 2 years), sex, and index date of admission (± 6 months). Conditional logistic regression was used to estimate crude and adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for associations between PPI use and infection-related hospitalizations. Analyses were adjusted for age, sex, polypharmacy, diabetes, heart failure, chronic obstructive pulmonary disease, myocardial infarction, cerebrovascular accident, and concomitant use of cancer and immunosuppressant medications. Subgroup analyses were performed for high- and low/moderate-intensity PPIs and for respiratory and non-respiratory infections. Logistic regression was used to compare the odds of infection-related hospitalizations among users of high- and low/moderate-intensity PPIs.

Results

Overall, 181 cases were matched to 354 controls. Preadmission PPI use was associated with infection-related hospitalizations (aOR 1.66; 95% CI 1.11–2.48). In subgroup analyses, the association was apparent only for respiratory infections (aOR 2.26; 95% CI 1.37–3.73) and high-intensity PPIs (aOR 1.93; 95% CI 1.23–3.04). However, the risk of infection-related hospitalization was not significantly higher among users of high- versus low/moderate-intensity PPIs (aOR 1.25; 95% CI 0.74–2.13).

Conclusion

Residents who use PPIs may be at increased risk of infection-related hospitalizations, particularly respiratory infections. Study findings provide further support for initiatives to minimize unnecessary PPI use in the LTCF setting.

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Authors and Affiliations

  1. Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University (Parkville Campus), 407 Royal Parade, Parkville, VIC, 3052, Australia

    Kate N. Wang, J. Simon Bell, Edwin C. K. Tan, Michael J. Dooley & Jenni Ilomäki

  2. Pharmacy Department, Alfred Health, Melbourne, VIC, Australia

    Kate N. Wang & Michael J. Dooley

  3. NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, NSW, Australia

    J. Simon Bell

  4. Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia

    J. Simon Bell, Julia F. M. Gilmartin-Thomas, Michael J. Dooley & Jenni Ilomäki

  5. School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia

    J. Simon Bell

  6. Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden

    Edwin C. K. Tan

  7. School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia

    Edwin C. K. Tan

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  1. Kate N. Wang
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  3. Edwin C. K. Tan
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Corresponding author

Correspondence to Kate N. Wang.

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Funding

KW is supported through an Australian Government Research Training Program Scholarship. JSB is supported by a National Health and Medical Research Council (NHMRC) Dementia Leadership Fellowship (#1140298). JG-T and ET are NHMRC-Australian Research Council (ARC) Dementia Research Development Fellows (APP1107476 and APP1107381). JI is supported by an NHMRC Early Career Research Fellowship (#1072137).

Conflict of interest

KW and MD are both currently employed by Alfred Health. JSB, ECKT, JFMG-T, and JI have no conflicts of interest that are directly relevant to the content of this article.

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Wang, K.N., Bell, J.S., Tan, E.C.K. et al. Proton Pump Inhibitors and Infection-Related Hospitalizations Among Residents of Long-Term Care Facilities: A Case–Control Study. Drugs Aging 36, 1027–1034 (2019). https://doi.org/10.1007/s40266-019-00704-6

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  • DOI: https://doi.org/10.1007/s40266-019-00704-6

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