The Association between Histamine 2 Receptor Antagonist Use and Clostridium difficile Infection: A Systematic Review and Meta-analysis
Clostridium difficile infection (CDI) is a major health problem. Epidemiological evidence suggests that there is an association between acid suppression therapy and development of CDI. We sought to systematically review the literature that examined the association between histamine 2 receptor antago...
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| Published in | PloS one Vol. 8; no. 3; p. e56498 |
|---|---|
| Main Authors | , , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
United States
Public Library of Science
04.03.2013
Public Library of Science (PLoS) |
| Subjects | |
| Online Access | Get full text |
| ISSN | 1932-6203 1932-6203 |
| DOI | 10.1371/journal.pone.0056498 |
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| Abstract | Clostridium difficile infection (CDI) is a major health problem. Epidemiological evidence suggests that there is an association between acid suppression therapy and development of CDI.
We sought to systematically review the literature that examined the association between histamine 2 receptor antagonists (H2RAs) and CDI.
We searched Medline, Current Contents, Embase, ISI Web of Science and Elsevier Scopus from 1990 to 2012 for all analytical studies that examined the association between H2RAs and CDI.
Two authors independently reviewed the studies for eligibility.
Data about studies characteristics, adjusted effect estimates and quality were extracted.
Thirty-five observations from 33 eligible studies that included 201834 participants were analyzed. Studies were performed in 6 countries and nine of them were multicenter. Most studies did not specify the type or duration of H2RAs therapy. The pooled effect estimate was 1.44, 95% CI (1.22-1.7), I(2) = 70.5%. This association was consistent across different subgroups (by study design and country) and there was no evidence of publication bias. The pooled effect estimate for high quality studies was 1.39 (1.15-1.68), I2 = 72.3%. Meta-regression analysis of 10 study-level variables did not identify sources of heterogeneity. In a speculative analysis, the number needed to harm (NNH) with H2RAs at 14 days after hospital admission in patients receiving antibiotics or not was 58, 95% CI (37, 115) and 425, 95% CI (267, 848), respectively. For the general population, the NNH at 1 year was 4549, 95% CI (2860, 9097).
In this rigorous systematic review and meta-analysis, we observed an association between H2RAs and CDI. The absolute risk of CDI associated with H2RAs is highest in hospitalized patients receiving antibiotics. |
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| AbstractList | BackgroundClostridium difficile infection (CDI) is a major health problem. Epidemiological evidence suggests that there is an association between acid suppression therapy and development of CDI.PurposeWe sought to systematically review the literature that examined the association between histamine 2 receptor antagonists (H2RAs) and CDI.Data sourceWe searched Medline, Current Contents, Embase, ISI Web of Science and Elsevier Scopus from 1990 to 2012 for all analytical studies that examined the association between H2RAs and CDI.Study selectionTwo authors independently reviewed the studies for eligibility.Data extractionData about studies characteristics, adjusted effect estimates and quality were extracted.Data synthesisThirty-five observations from 33 eligible studies that included 201834 participants were analyzed. Studies were performed in 6 countries and nine of them were multicenter. Most studies did not specify the type or duration of H2RAs therapy. The pooled effect estimate was 1.44, 95% CI (1.22-1.7), I(2) = 70.5%. This association was consistent across different subgroups (by study design and country) and there was no evidence of publication bias. The pooled effect estimate for high quality studies was 1.39 (1.15-1.68), I2 = 72.3%. Meta-regression analysis of 10 study-level variables did not identify sources of heterogeneity. In a speculative analysis, the number needed to harm (NNH) with H2RAs at 14 days after hospital admission in patients receiving antibiotics or not was 58, 95% CI (37, 115) and 425, 95% CI (267, 848), respectively. For the general population, the NNH at 1 year was 4549, 95% CI (2860, 9097).ConclusionIn this rigorous systematic review and meta-analysis, we observed an association between H2RAs and CDI. The absolute risk of CDI associated with H2RAs is highest in hospitalized patients receiving antibiotics. Background Clostridium difficile infection (CDI) is a major health problem. Epidemiological evidence suggests that there is an association between acid suppression therapy and development of CDI. Purpose We sought to systematically review the literature that examined the association between histamine 2 receptor antagonists (H 2 RAs) and CDI. Data source We searched Medline, Current Contents, Embase, ISI Web of Science and Elsevier Scopus from 1990 to 2012 for all analytical studies that examined the association between H 2 RAs and CDI. Study selection Two authors independently reviewed the studies for eligibility. Data extraction Data about studies characteristics, adjusted effect estimates and quality were extracted. Data synthesis Thirty-five observations from 33 eligible studies that included 201834 participants were analyzed. Studies were performed in 6 countries and nine of them were multicenter. Most studies did not specify the type or duration of H 2 RAs therapy. The pooled effect estimate was 1.44, 95% CI (1.22–1.7), I 2 = 70.5%. This association was consistent across different subgroups (by study design and country) and there was no evidence of publication bias. The pooled effect estimate for high quality studies was 1.39 (1.15–1.68), I2 = 72.3%. Meta-regression analysis of 10 study-level variables did not identify sources of heterogeneity. In a speculative analysis, the number needed to harm (NNH) with H 2 RAs at 14 days after hospital admission in patients receiving antibiotics or not was 58, 95% CI (37, 115) and 425, 95% CI (267, 848), respectively. For the general population, the NNH at 1 year was 4549, 95% CI (2860, 9097). Conclusion In this rigorous systematic review and meta-analysis, we observed an association between H 2 RAs and CDI. The absolute risk of CDI associated with H 2 RAs is highest in hospitalized patients receiving antibiotics. Background Clostridium difficile infection (CDI) is a major health problem. Epidemiological evidence suggests that there is an association between acid suppression therapy and development of CDI. Purpose We sought to systematically review the literature that examined the association between histamine 2 receptor antagonists (H.sub.2 RAs) and CDI. Data source We searched Medline, Current Contents, Embase, ISI Web of Science and Elsevier Scopus from 1990 to 2012 for all analytical studies that examined the association between H.sub.2 RAs and CDI. Study selection Two authors independently reviewed the studies for eligibility. Data extraction Data about studies characteristics, adjusted effect estimates and quality were extracted. Data synthesis Thirty-five observations from 33 eligible studies that included 201834 participants were analyzed. Studies were performed in 6 countries and nine of them were multicenter. Most studies did not specify the type or duration of H.sub.2 RAs therapy. The pooled effect estimate was 1.44, 95% CI (1.22-1.7), I.sup.2 = 70.5%. This association was consistent across different subgroups (by study design and country) and there was no evidence of publication bias. The pooled effect estimate for high quality studies was 1.39 (1.15-1.68), I2 = 72.3%. Meta-regression analysis of 10 study-level variables did not identify sources of heterogeneity. In a speculative analysis, the number needed to harm (NNH) with H.sub.2 RAs at 14 days after hospital admission in patients receiving antibiotics or not was 58, 95% CI (37, 115) and 425, 95% CI (267, 848), respectively. For the general population, the NNH at 1 year was 4549, 95% CI (2860, 9097). Conclusion In this rigorous systematic review and meta-analysis, we observed an association between H.sub.2 RAs and CDI. The absolute risk of CDI associated with H.sub.2 RAs is highest in hospitalized patients receiving antibiotics. Clostridium difficile infection (CDI) is a major health problem. Epidemiological evidence suggests that there is an association between acid suppression therapy and development of CDI. We sought to systematically review the literature that examined the association between histamine 2 receptor antagonists (H.sub.2 RAs) and CDI. In this rigorous systematic review and meta-analysis, we observed an association between H.sub.2 RAs and CDI. The absolute risk of CDI associated with H.sub.2 RAs is highest in hospitalized patients receiving antibiotics. Background Clostridium difficile infection (CDI) is a major health problem. Epidemiological evidence suggests that there is an association between acid suppression therapy and development of CDI. Purpose We sought to systematically review the literature that examined the association between histamine 2 receptor antagonists (H2RAs) and CDI. Data source We searched Medline, Current Contents, Embase, ISI Web of Science and Elsevier Scopus from 1990 to 2012 for all analytical studies that examined the association between H2RAs and CDI. Study selection Two authors independently reviewed the studies for eligibility. Data extraction Data about studies characteristics, adjusted effect estimates and quality were extracted. Data synthesis Thirty-five observations from 33 eligible studies that included 201834 participants were analyzed. Studies were performed in 6 countries and nine of them were multicenter. Most studies did not specify the type or duration of H2RAs therapy. The pooled effect estimate was 1.44, 95% CI (1.22–1.7), I2 = 70.5%. This association was consistent across different subgroups (by study design and country) and there was no evidence of publication bias. The pooled effect estimate for high quality studies was 1.39 (1.15–1.68), I2 = 72.3%. Meta-regression analysis of 10 study-level variables did not identify sources of heterogeneity. In a speculative analysis, the number needed to harm (NNH) with H2RAs at 14 days after hospital admission in patients receiving antibiotics or not was 58, 95% CI (37, 115) and 425, 95% CI (267, 848), respectively. For the general population, the NNH at 1 year was 4549, 95% CI (2860, 9097). Conclusion In this rigorous systematic review and meta-analysis, we observed an association between H2RAs and CDI. The absolute risk of CDI associated with H2RAs is highest in hospitalized patients receiving antibiotics. Clostridium difficile infection (CDI) is a major health problem. Epidemiological evidence suggests that there is an association between acid suppression therapy and development of CDI. We sought to systematically review the literature that examined the association between histamine 2 receptor antagonists (H2RAs) and CDI. We searched Medline, Current Contents, Embase, ISI Web of Science and Elsevier Scopus from 1990 to 2012 for all analytical studies that examined the association between H2RAs and CDI. Two authors independently reviewed the studies for eligibility. Data about studies characteristics, adjusted effect estimates and quality were extracted. Thirty-five observations from 33 eligible studies that included 201834 participants were analyzed. Studies were performed in 6 countries and nine of them were multicenter. Most studies did not specify the type or duration of H2RAs therapy. The pooled effect estimate was 1.44, 95% CI (1.22-1.7), I(2) = 70.5%. This association was consistent across different subgroups (by study design and country) and there was no evidence of publication bias. The pooled effect estimate for high quality studies was 1.39 (1.15-1.68), I2 = 72.3%. Meta-regression analysis of 10 study-level variables did not identify sources of heterogeneity. In a speculative analysis, the number needed to harm (NNH) with H2RAs at 14 days after hospital admission in patients receiving antibiotics or not was 58, 95% CI (37, 115) and 425, 95% CI (267, 848), respectively. For the general population, the NNH at 1 year was 4549, 95% CI (2860, 9097). In this rigorous systematic review and meta-analysis, we observed an association between H2RAs and CDI. The absolute risk of CDI associated with H2RAs is highest in hospitalized patients receiving antibiotics. Clostridium difficile infection (CDI) is a major health problem. Epidemiological evidence suggests that there is an association between acid suppression therapy and development of CDI.BACKGROUNDClostridium difficile infection (CDI) is a major health problem. Epidemiological evidence suggests that there is an association between acid suppression therapy and development of CDI.We sought to systematically review the literature that examined the association between histamine 2 receptor antagonists (H2RAs) and CDI.PURPOSEWe sought to systematically review the literature that examined the association between histamine 2 receptor antagonists (H2RAs) and CDI.We searched Medline, Current Contents, Embase, ISI Web of Science and Elsevier Scopus from 1990 to 2012 for all analytical studies that examined the association between H2RAs and CDI.DATA SOURCEWe searched Medline, Current Contents, Embase, ISI Web of Science and Elsevier Scopus from 1990 to 2012 for all analytical studies that examined the association between H2RAs and CDI.Two authors independently reviewed the studies for eligibility.STUDY SELECTIONTwo authors independently reviewed the studies for eligibility.Data about studies characteristics, adjusted effect estimates and quality were extracted.DATA EXTRACTIONData about studies characteristics, adjusted effect estimates and quality were extracted.Thirty-five observations from 33 eligible studies that included 201834 participants were analyzed. Studies were performed in 6 countries and nine of them were multicenter. Most studies did not specify the type or duration of H2RAs therapy. The pooled effect estimate was 1.44, 95% CI (1.22-1.7), I(2) = 70.5%. This association was consistent across different subgroups (by study design and country) and there was no evidence of publication bias. The pooled effect estimate for high quality studies was 1.39 (1.15-1.68), I2 = 72.3%. Meta-regression analysis of 10 study-level variables did not identify sources of heterogeneity. In a speculative analysis, the number needed to harm (NNH) with H2RAs at 14 days after hospital admission in patients receiving antibiotics or not was 58, 95% CI (37, 115) and 425, 95% CI (267, 848), respectively. For the general population, the NNH at 1 year was 4549, 95% CI (2860, 9097).DATA SYNTHESISThirty-five observations from 33 eligible studies that included 201834 participants were analyzed. Studies were performed in 6 countries and nine of them were multicenter. Most studies did not specify the type or duration of H2RAs therapy. The pooled effect estimate was 1.44, 95% CI (1.22-1.7), I(2) = 70.5%. This association was consistent across different subgroups (by study design and country) and there was no evidence of publication bias. The pooled effect estimate for high quality studies was 1.39 (1.15-1.68), I2 = 72.3%. Meta-regression analysis of 10 study-level variables did not identify sources of heterogeneity. In a speculative analysis, the number needed to harm (NNH) with H2RAs at 14 days after hospital admission in patients receiving antibiotics or not was 58, 95% CI (37, 115) and 425, 95% CI (267, 848), respectively. For the general population, the NNH at 1 year was 4549, 95% CI (2860, 9097).In this rigorous systematic review and meta-analysis, we observed an association between H2RAs and CDI. The absolute risk of CDI associated with H2RAs is highest in hospitalized patients receiving antibiotics.CONCLUSIONIn this rigorous systematic review and meta-analysis, we observed an association between H2RAs and CDI. The absolute risk of CDI associated with H2RAs is highest in hospitalized patients receiving antibiotics. |
| Audience | Academic |
| Author | Riaz, Muhammad Erwin, Patricia J. Garbati, Musa A. Khan, Abdur Rahman Al-Tannir, Mohamad Baddour, Larry M. AlGhamdi, Mushabab Alasmari, Faisal A. Sutton, Alex J. Tleyjeh, Imad M. Abdulhak, Aref A. Bin |
| AuthorAffiliation | 4 Department of Internal Medicine, School of Medicine, University of Missouri – Kansas City, Kansas City, Missouri, United States of America 8 Department of Health Sciences, University of Leicester, Leicester, England 1 Department of Medicine, King Fahad Medical City, Riyadh, Saudi Arabia 3 Division of Epidemiology, Mayo Clinic, S.W, Rochester, Minnesota, United States of America Universidad Peruana de Ciencias Aplicadas (UPC), Peru 2 Division of Infectious Diseases, Mayo Clinic, S.W, Rochester, Minnesota, United States of America 6 Department of Internal Medicine, University of Toledo Medical Center, Toledo, Ohio, United States of America 5 Research and Scientific Publication Center, King Fahad Medical City, Riyadh, Riyadh, Saudi Arabia 7 Mayo Medical Library, Mayo Clinic, S.W, Rochester, Minnesota, United States of America |
| AuthorAffiliation_xml | – name: 4 Department of Internal Medicine, School of Medicine, University of Missouri – Kansas City, Kansas City, Missouri, United States of America – name: 7 Mayo Medical Library, Mayo Clinic, S.W, Rochester, Minnesota, United States of America – name: Universidad Peruana de Ciencias Aplicadas (UPC), Peru – name: 1 Department of Medicine, King Fahad Medical City, Riyadh, Saudi Arabia – name: 8 Department of Health Sciences, University of Leicester, Leicester, England – name: 5 Research and Scientific Publication Center, King Fahad Medical City, Riyadh, Riyadh, Saudi Arabia – name: 3 Division of Epidemiology, Mayo Clinic, S.W, Rochester, Minnesota, United States of America – name: 6 Department of Internal Medicine, University of Toledo Medical Center, Toledo, Ohio, United States of America – name: 2 Division of Infectious Diseases, Mayo Clinic, S.W, Rochester, Minnesota, United States of America |
| Author_xml | – sequence: 1 givenname: Imad M. surname: Tleyjeh fullname: Tleyjeh, Imad M. – sequence: 2 givenname: Aref A. Bin surname: Abdulhak fullname: Abdulhak, Aref A. Bin – sequence: 3 givenname: Muhammad surname: Riaz fullname: Riaz, Muhammad – sequence: 4 givenname: Musa A. surname: Garbati fullname: Garbati, Musa A. – sequence: 5 givenname: Mohamad surname: Al-Tannir fullname: Al-Tannir, Mohamad – sequence: 6 givenname: Faisal A. surname: Alasmari fullname: Alasmari, Faisal A. – sequence: 7 givenname: Mushabab surname: AlGhamdi fullname: AlGhamdi, Mushabab – sequence: 8 givenname: Abdur Rahman surname: Khan fullname: Khan, Abdur Rahman – sequence: 9 givenname: Patricia J. surname: Erwin fullname: Erwin, Patricia J. – sequence: 10 givenname: Alex J. surname: Sutton fullname: Sutton, Alex J. – sequence: 11 givenname: Larry M. surname: Baddour fullname: Baddour, Larry M. |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/23469173$$D View this record in MEDLINE/PubMed |
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| Copyright | COPYRIGHT 2013 Public Library of Science 2013 Tleyjeh et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License: https://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License. 2013 Tleyjeh et al 2013 Tleyjeh et al |
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| Snippet | Clostridium difficile infection (CDI) is a major health problem. Epidemiological evidence suggests that there is an association between acid suppression... Background Clostridium difficile infection (CDI) is a major health problem. Epidemiological evidence suggests that there is an association between acid... BackgroundClostridium difficile infection (CDI) is a major health problem. Epidemiological evidence suggests that there is an association between acid... Background Clostridium difficile infection (CDI) is a major health problem. Epidemiological evidence suggests that there is an association between acid... |
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| SubjectTerms | Acids Adolescent Adult Anti-Bacterial Agents - administration & dosage Anti-Bacterial Agents - adverse effects Antibiotics Bibliographic data bases Biology Case-Control Studies Clostridioides difficile - drug effects Clostridioides difficile - growth & development Clostridium difficile Clostridium infections Data collection Development and progression Diarrhea Drug therapy Enterocolitis, Pseudomembranous - drug therapy Enterocolitis, Pseudomembranous - microbiology Epidemics Epidemiology Female Heterogeneity Histamine Histamine H2 antagonists Histamine H2 Antagonists - administration & dosage Histamine H2 Antagonists - adverse effects Hospitalization Hospitals Humans Infections Infectious diseases Internal medicine Literature reviews Male Medical ethics Medical libraries Medicine Meta-analysis Patient outcomes Patients Receptors, Histamine H2 - metabolism Regression Analysis Risk Factors Studies Subgroups Subject heading schemes Systematic review Therapy |
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| Title | The Association between Histamine 2 Receptor Antagonist Use and Clostridium difficile Infection: A Systematic Review and Meta-analysis |
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