{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T20:28:48Z","timestamp":1790281728970,"version":"4.1.0"},"reference-count":69,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2024,1,24]],"date-time":"2024-01-24T00:00:00Z","timestamp":1706054400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Centre for Translational Microbiome Research"},{"name":"Karolinska Instituted, Sweden"},{"name":"Research Collaboration Agreement with Ferring Pharmaceuticals"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,3,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Antibiotics and proton pump inhibitors (PPI) are recognized risk factors for acquisition and recurrence of Clostridioides difficile infection (CDI), yet combined effects remain unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To assess the short- and long-term effects of antibiotics and PPIs on CDI risk and recurrence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Population-based study including all 43\u200a152 patients diagnosed with CDI in Sweden (2006\u20132019), and 355\u200a172 matched population controls without CDI. The impact of antibiotics and PPIs on CDI risk and recurrence was explored for recent (0\u201330 days) and preceding (31\u2013180 days) use prior to their first CDI diagnosis, using multivariable conditional logistic regression presented as odds ratios (ORs) and 95% confidence interval, adjusted for demographics, comorbidities and other drugs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Compared to controls, the combined effect of recent PPIs and antibiotics [ORAB+PPI\u200a=\u200a17.51 (17.48\u201317.53)] on CDI risk was stronger than the individual effects [ORAB\u200a=\u200a15.37 (14.83\u201315.93); ORPPI\u200a=\u200a2.65 (2.54\u20132.76)]. Results were less pronounced for exposure during the preceding months. Dose\u2013response analyses showed increasing exposure correlated with CDI risk [recent use: ORAB\u200a=\u200a6.32 (6.15\u20136.49); ORPPI\u200a=\u200a1.65 (1.62\u20131.68) per prescription increase].<\/jats:p>\n                    <jats:p>Compared to individuals without recurrence (rCDI), recent [ORAB\u200a=\u200a1.30 (1.23\u20131.38)] and preceding [ORAB\u200a=\u200a1.23 (1.16\u20131.31); ORPPI\u200a=\u200a1.12 (1.03\u20131.21)] use also affected the risk of recurrence yet without significant interaction between both. Recent macrolides\/lincosamides\/streptogramins; other antibacterials including nitroimidazole derivates; non-penicillin beta lactams and quinolones showed the strongest association with CDI risk and recurrence, particularly for recent use. PPI use, both recent and preceding, further increased the CDI risk associated with almost all antibiotic classes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Recent and less recent use of PPIs and systemic antibiotics was associated with an increased risk of CDI, particularly in combination.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/jac\/dkae012","type":"journal-article","created":{"date-parts":[[2024,1,9]],"date-time":"2024-01-09T08:23:52Z","timestamp":1704788632000},"page":"608-616","source":"Crossref","is-referenced-by-count":25,"title":["The combined effect of systemic antibiotics and proton pump inhibitors on\n                    <i>Clostridioides difficile<\/i>\n                    infection and recurrence"],"prefix":"10.1093","volume":"79","author":[{"given":"Nele","family":"Moreels","sequence":"first","affiliation":[{"name":"Department of 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