Shiraishi Chihiro, Kato Hideo, Iwamoto Takuya
Department of Emergency and Disaster Medical Pharmacy, Faculty of Pharmaceutical Sciences, Fukuoka University, Fukuoka, Japan.
Department of Pharmacy, Mie University Hospital, Mie, Japan.
Infect Drug Resist. 2025 Aug 31;18:4593-4602. doi: 10.2147/IDR.S543864. eCollection 2025.
The comparative effectiveness and potential impact of individual proton pump inhibitors (PPIs) on the development of infection (CDI) remain unclear. Additionally, there is insufficient evidence to support the use of probiotics for CDI prevention outside clinical trials. This study aimed to identify the PPIs that are most associated with CDI development and to determine whether probiotic co-administration can reduce this risk.
We retrospectively analyzed the data of 3287 patients tested for CDI at Mie University Hospital between January 2014 and June 2024, excluding 1917 patients who had received antibiotics within the prior 3 months. The PPIs studied included esomeprazole, omeprazole, rabeprazole, and lansoprazole.
Univariate logistic regression analysis revealed age and esomeprazole use as potential risk factors for CDI ( = 0.009). Although not significant, the co-administration of probiotics tended to reduce the incidence of CDI in patients receiving esomeprazole (3.8% vs 10.4%, = 0.060). Patients prescribed vonoprazan had a significantly higher rate of concomitant probiotic use than did those prescribed esomeprazole ( = 0.025).
Our findings suggest that esomeprazole use and advanced age may increase the risk of CDI. Additionally, probiotics may help prevent CDI during PPI therapy. Selecting PPIs based on individual bleeding profiles and considering probiotics could be beneficial to mitigate the risk of CDI.
个体质子泵抑制剂（PPI）对艰难梭菌感染（CDI）发生发展的相对有效性和潜在影响仍不明确。此外，尚无充分证据支持在临床试验之外使用益生菌预防CDI。本研究旨在确定与CDI发生最相关的PPI，并确定联合使用益生菌是否可降低此风险。
我们回顾性分析了2014年1月至2024年6月在三重大学医院接受CDI检测的3287例患者的数据，排除了在过去3个月内接受过抗生素治疗的1917例患者。所研究的PPI包括埃索美拉唑、奥美拉唑、雷贝拉唑和兰索拉唑。
单因素逻辑回归分析显示年龄和使用埃索美拉唑是CDI的潜在危险因素（P = 0.009）。虽然不显著，但联合使用益生菌倾向于降低接受埃索美拉唑治疗患者的CDI发生率（3.8%对10.4%，P = 0.060）。服用沃克的患者同时使用益生菌的比例显著高于服用埃索美拉唑的患者（P = 0.025）。
我们的研究结果表明，使用埃索美拉唑和高龄可能会增加CDI的风险。此外，益生菌可能有助于在PPI治疗期间预防CDI。根据个体出血情况选择PPI并考虑使用益生菌可能有助于降低CDI风险。
