Association Between Bisphosphonates and Hospitalized Clostridioides difficile Infection Among Frail Older Adults.
Kevin W McConeghy, Andrew R Zullo, Christine W Lary and 5 others
PMID 31932139WHAT IT FOUND
Frail nursing home residents who started bisphosphonates did not show higher hospitalization for C difficile infection than residents who started calcitonin.
This paper alone is not a reason to avoid bisphosphonates solely for C difficile infection concern.
Key findings
01In the matched cohort, hospitalized C difficile infection was 1.6% among bisphosphonate users and 1.4% among calcitonin users.
02The paper reported a hazard ratio of 1.11 (95% CI: 0.81 to 1.52) in the matched cohort and describes the difference as highly compatible with chance.
03Within 60 days, antibiotics were prescribed in 40.9% and 42.7% of matched users, and PPIs in 67.1% and 66.8%, respectively.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Hospitalization for C difficile infection was identified from administrative billing codes, so milder infections in nursing homes may not have been captured. New calcitonin users may still differ from new bisphosphonate users even after matching. The propensity score model may miss important confounders or be affected by complex causal pathways. The matched sample may not be large enough to detect small effects. Death is a competing risk in frail older adults and can affect interpretation.
The easy way to misread this
Do not conclude that bisphosphonates are completely safe for C difficile infection. This study did not show a higher risk of hospitalization for C difficile infection, but it captured only hospitalizations, compared new users of two medications, and may not detect small effects.