Preparation and characterization of pectin/hydroxyethyl cellulose/clay/TiO2 bionanocomposite films for microbial pathogen removal from contaminated water.

Some of conventional wastewater disinfectants can have a harmful influence on the environment as well as human health. The aim of this investigation was synthesis and characterizes ecofriendly pectin/hydroxyethyl cellulose (HEC)/clay and pectin/HEC/clay incorporated with titanium dioxide nanoparticles (TiO2NPs) and use the prepared bionanocomposite as microbial disinfectants for real wastewater. Pectin/HEC/clay and pectin/HEC/clay/TiO2 bionanocomposite were characterized by various methods including X-ray diffraction (XRD), scanning electron microscope (SEM), and Fourier-transform infrared spectroscopy (FTIR), thermal gravimetric analysis (TGA). Mechanical properties and water vapor permeability (WVP) were carried out. The results of SEM showed that, the prepared bionanocomposite had a smooth surface. Additionally, TiO2 nanoparticles to the pectin/HEC/clay composites may lead to changes in the FTIR spectrum. The intensity of XRD peaks indicated that, TiO2NPs was small size crystallite. TGA illustrated that pectin has moderate thermal stability, while HEC generally exhibits good thermal stability. The TEM showed that, TiO2 nanoparticles have diameters <25 nm. On the other hand, antimicrobial activities of pectin/HEC/clay against Escherichia coli (E. coli), Staphylococcus aureus and Candida albicans have been enhanced by adding TiO2NPs. The minimum inhibitory concentration (MIC) of pectin/HEC/clay/TiO2 against E. coli was 200 mg/mL. Moreover, complete eradication of E. coli, Salmonella and Candida spp. from real wastewater was observed by using pectin/HEC/clay/TiO2 bionanocomposite. Finally, it can be concluded that, the synthesized bionanocomposite is environmentally friendly and considered an excellent disinfectant matter for removal of the microbial pathogens from wastewater to safely reuse.

Cold atmospheric plasma: a sustainable approach to inactivating viruses, bacteria, and protozoa with remediation of organic pollutants in river water and wastewater.

Innovative technologies are needed to enhance access to clean water and avoid waterborne diseases. We investigated the performance of cold atmospheric plasma (CAP), a clean and sustainable approach for microbial inactivation and total organic carbon (TOC) degradation in environmental water. Water matrices played a crucial role in the performance of CAP efficacy; for example, complete removal of ɸX174 from dH2O required 1 min of treatment, while ɸX174 reductions of ~ 2log10 and 4log10 were obtained after 10 min of CAP exposure in river water and wastewater samples, respectively. Similarly, after 10 min of CAP treatment, bacterial concentrations decreased by 3 log10 and 4 log10, in river and wastewater samples, respectively. In contrast, after 30 s of contact time, a 4 log10 reduction of bacteria was accomplished in dH2O. Complete removal of Acanthamoeba from dH2O was found after 30 min of CAP treatment, whereas it was not removed from surface water or wastewater at the same exposure time. Additionally, the approach successfully reduced TOC, and the degradation kinetics of TOC were represented by pseudo-first-order. CAP showed higher rates of TOC degradation in the final effluent of the wastewater treatment plant compared to surface water. The difference in CAP performance between river water and wastewater could be attributed to the bulk structure of humic acids in river water compared to small organic byproducts in the final effluent of WWTP. Overall, the findings reported here support the idea that CAP holds promise as a sustainable solution for controlling pathogens, removing organic water pollution, and integrating with traditional purification processes. Low-cost systems may advance CAP technology and increase its widespread use.

Bioactive Azadirachta indica and Melia azedarach leaves extracts with anti-SARS-CoV-2 and antibacterial activities.

The leaves of Azadirachta indica L. and Melia azedarach L., belonging to Meliaceae family, have been shown to have medicinal benefits and are extensively employed in traditional folk medicine. Herein, HPLC analysis of the ethyl acetate fraction of the total methanolic extract emphasized the enrichment of both A. indica L., and M. azedarach L. leaves extracts with phenolic and flavonoids composites, respectively. Besides, 4 limonoids and 2 flavonoids were isolated using column chromatography. By assessing the in vitro antiviral activities of both total leaves extracts against Severe Acute Respiratory Syndrome Corona virus 2 (SARS-CoV-2), it was found that A. indica L. and M. azedarach L. have robust anti-SARS-CoV-2 activities at low half-maximal inhibitory concentrations (IC50) of 8.451 and 6.922 µg/mL, respectively. Due to the high safety of A. indica L. and M. azedarach L. extracts with half-maximal cytotoxic concentrations (CC50) of 446.2 and 351.4 µg/ml, respectively, both displayed extraordinary selectivity indices (SI>50). A. indica L. and M. azedarach L. leaves extracts could induce antibacterial activities against both Gram-negative and positive bacterial strains. The minimal inhibitory concentrations of A. indica L. and M. azedarach L. leaves extracts varied from 25 to 100 mg/mL within 30 min contact time towards the tested bacteria. Our findings confirm the broad-spectrum medicinal value of A. indica L. and M. azedarach L. leaves extracts. Finally, additional in vivo investigations are highly recommended to confirm the anti-COVID-19 and antimicrobial activities of both plant extracts.

New insights for tracking bacterial community structures in industrial wastewater from textile factories to surface water using phenotypic, 16S rRNA isolates identifications and high-throughput sequencing.

Industrial wastewater can possibly change the microbial ecological environment. There are few studies that focus on the bacterial variety in textile wastewater effluents and after combination with domestic wastewater. Thus, this study aimed to determine dye degrading bacteria from textile wastewater and environmental water samples using cultural method followed by phenotypic using BIOLOG and genotypic identification (16S rRNA) for dye degrading isolates identifications. Moreover, the bacterial communities in three textile and four environmental samples using Illumina MiSeq high-throughput sequencing were investigated. The findings revealed that in textile water samples, the ratio of dye-degrading bacteria (DDB) to total bacterial counts (TBC) was 27%. The identified DDB genera by 16S rRNA based on the cultural approach were Citrobacter spp., Klebsiella spp., Enterobacter spp., Pseudomonas spp., and Aeromonas spp. Regarding to the metagenomics analyses, the environmental samples had 5,598 Operational Toxanomic Units (OTUs) more than textile wastewater samples (1,463 OTUs). Additionally, the most abundant phyla in the textile wastewater were Proteobacteria (24.45-94.83%), Bacteriodetes (0.5-44.84%) and Firmicutes (3.72-67.40%), while, Proteobacteria (30.8-76.3%), bacteroidetes (8.5-50%) and Acentobacteria (0.5-23.12%) were the most abundant phyla in the environmental samples. The maximum abundant bacteria at species level in environmental samples were Aquabacterium parvum (36.71%), Delftia tsuruhatensis (17.61%), Parabacteriodes chartae (15.39%) and Methylorubrum populi (7.51%) in El-Rahawy Drain water (RDW), River Nile water (RNW), wastewater (RWW) from WWTP in Zennin and El-Rahawy Drain sediment (RDS), respectively, whereas the maximum abundant bacteria at species level in textile wastewater were Alkalibacterium pelagium (34.11%), Enterobacter kobei (26.09%) and Chryseobacterium montanum (16.93%) in factory 1 (HBT) sample, SHB sample (before mixing with domestic wastewater) and SHB sample (after mixing with domestic wastewater), respectively. In conclusion, the microbial communities in textile wastewaters are similar to those in environmental samples at the phylum level but distinct at the genus and species levels because they are exposed to a wider range of environmental circumstances.

Biosorption kinetics of cerium(III) and cobalt(II) from liquid wastes using individual bacterial species isolated from low-level liquid radioactive wastes.

The existence of toxic heavy metals in the aquatic environment has emphasized a considerable exigency to develop several multifunctional biosorbents for their removal. Herein, three individual bacterial species of Cellulosimicrobium cellulans, Bacillus coagulans, and Microbacterium testaceum were successfully isolated from low-level liquid radioactive wastes. Their loading capacities towards cerium and cobalt metal ions were inclusivity inspected under variable operational parameters of pH, primary pollutant concentration, interaction time, temperature, stirring speed, and biosorbent dosage. By analyzing the influence of solution pH, concentration, temperature, biosorbent mass, and agitation speed on the biosorption kinetics, the biosorption process confirms pseudo-second-order kinetic, intraparticle diffusion, and Elovich equation. Remarkably, the isolated Microbacterium testaceum exhibited high loading capacities reaching 68.1 mg g-1, and 49.6 mg g-1 towards Ce(III), and Co(II) ions, respectively, at the initial concentration of 2.8 mM, pH 4.5, and 25 °C. Overall, the isolated bacterial species can potentially be offered up as a promising scavenger for Ce(III) and Co(II) from liquid waste effluents.

Emerging Bioanalytical Devices and Platforms for Rapid Detection of Pathogens in Environmental Samples.

The development of robust bioanalytical devices and biosensors for infectious pathogens is progressing well with the advent of new materials, concepts, and technology. The progress is also stepping towards developing high throughput screening technologies that can quickly identify, differentiate, and determine the concentration of harmful pathogens, facilitating the decision-making process for their elimination and therapeutic interventions in large-scale operations. Recently, much effort has been focused on upgrading these analytical devices to an intelligent technological platform by integrating them with modern communication systems, such as the internet of things (IoT) and machine learning (ML), to expand their application horizon. This review outlines the recent development and applications of bioanalytical devices and biosensors to detect pathogenic microbes in environmental samples. First, the nature of the recent outbreaks of pathogenic microbes such as foodborne, waterborne, and airborne pathogens and microbial toxins are discussed to understand the severity of the problems. Next, the discussion focuses on the detection systems chronologically, starting with the conventional methods, advanced techniques, and emerging technologies, such as biosensors and other portable devices and detection platforms for pathogens. Finally, the progress on multiplex assays, wearable devices, and integration of smartphone technologies to facilitate pathogen detection systems for wider applications are highlighted.

Temporal phytoremediation potential for heavy metals and bacterial abundance in drainage water.

Drainage water in developing countries has a high abundance of pathogenic bacteria and high levels of toxic and mutagenic pollutants. Remediation of drainage water is important in water-poor counties, especially with the growing need to secure sustainability of safe water resources to fulfill increasing demands for agriculture. Here, we assess the efficiency of macrophyte Pistia stratiotes to remediate a polluted drain in Egypt, rich in macronutrients, heavy metals, and different types of pathogenic and non-pathogenic bacteria. Drainage water was sampled monthly, for a year, to assess seasonal changes in bacterial abundance, water physicochemical properties (transparency, temperature, dissolved oxygen, EC, pH, N, P, and K), and heavy metals contents (Pb, Zn, and Co) in a polluted drain dominated with P. stratiotes. The ability of P. stratiotes to rhizofiltrate the three heavy metals was calculated. The results showed seasonal variations in the plant rhizofiltration potential of Co and Salmonella abundance. The highest values of dissolved oxygen (12.36 mg/L) and macronutrient elements (N and P) were attained in the winter. The counts of total coliform, fecal coliform, fecal streptococci, and in Salmonella spp. were the highest in the summer. P. stratiotes accumulated Pb more than Zn and Co. The highest levels of rhizofiltration were in summer for Pb and Co and in the autumn for Zn. Canonical correspondence analysis (CCA) showed that the variation in the bacterial abundance and plant rhizofiltration potential was strongly and significantly affected by water-dissolved oxygen. Moreover, the rhizofiltration potential of Pb and Co showed a positive correlation with water N. Overall, P. stratiotes could be proposed as a potential biomonitor for heavy metals in polluted water.

The occurrence of opioid compounds in wastewater treatment plants and their receiving water bodies in Gauteng province, South Africa.

The continuous influx of opioid compounds into aquatic environments has become an increasing and persistent concern, due to their extensive use. This is especially alarming as wastewater treatment plants (WWTPs) are unable to completely remove them. Despite the reported health concerns, the occurrence of opioid compounds in the environment has not received much attention. The present study investigates the occurrence of 19 opioids in four WWTPs and their respective receiving water bodies. All wastewater samples revealed opioids at concentration ranging from ng/L to µg/L with most influents having higher concentrations than effluents. WWTPs appeared to perform poorly (p > 0.05 between influents and effluents), and were unable to remove some opioids including Methadone (-27.3%) from the Leeuwkuil WWTP, Codeine (-21.7%) and Thebaine (-3.77%) from the Sandspruit WWTP, and Hydrocodone (-1.06%) from the Meyerton WWTP, respectively. Samples collected from the Leeuwkuil WWTP were the most contaminated, with eighteen out of nineteen opioid analogues exceeding 1 µg/L. Upstream surface water contained less opioids (most < LOQ) than downstream (p < 0.05), with Hydrocodone, Oxycodone, Hydromorphone, Fentanyl, Ketamine and Dihydrocodeine not detected. The occurrence of high concentrations of opioid analogues in downstream surface water (298 ng/L -10.8 µg/L for Klip River, 4.49 ng/L -13.1 µg/L for Vaal River, 70.5 ng/L -10.0 µg/L for Soutspruit River and 8.0 ng/L - 2.43 µg/L for Sun Spruit River) was directly linked to their mass loads in the respective wastewater effluent samples.

Phytoremediation Perspectives of Seven Aquatic Macrophytes for Removal of Heavy Metals from Polluted Drains in the Nile Delta of Egypt.

The current study addressed the heavy metals accumulation potentials of seven perennial aquatic macrophytes (Cyperus alopecuroides, Echinochloa stagnina, Eichhornia crassipes, Ludwigia stolonifera, Phragmites australis, Ranunculus sceleratus and Typha domingensis) and the pollution status of three drains (Amar, El-Westany and Omar-Beck) in the Nile Delta of Egypt. Nine sites at each drain were sampled for sediment and plant analyses. Concentrations of eight metals (Fe, Cu, Zn, Mn, Co, Cd, Ni, and Pb) were determined in the sediment and the aboveground and belowground tissues of the selected macrophytes. Bioaccumulation factor (BF) and translocation factor (TF) were computed for each species. The sediment heavy metals concentrations of the three drains occurred in the following order: El-Westany > Amar > Omar-Beck. The concentrations of sediment heavy metals in the three drains were ordered as follows: Fe (438.45-615.17 mg kg-1) > Mn (341.22-481.09 mg kg-1) > Zn (245.08-383.19 mg kg-1) > Cu (205.41-289.56 mg kg-1) > Pb (31.49-97.73 mg kg-1) > Cd (13.97-55.99 mg kg-1) > Ni (14.36-39.34 mg kg-1) > Co (1.25-3.51 mg kg-1). The sediment exceeded the worldwide permissible ranges of Cu, Zn and Pb, but ranged within safe limits for Mn, Cd, Ni and Co. P. australis accumulated the highest concentrations of Fe, Co, Cd and Ni, while E. crassipes contained the highest concentrations of Cu, Zn, Mn, and Pb. Except for C. alopecuroides and Cu metal, the studied species had BF values greater than one for the investigated heavy metals. Nevertheless, the TFs of all species (except Cd in L. stolonifera) were less than one. Hence, the studied species are appropriate for accumulation, biomonitoring, and phytostabilization of the investigated metals.

Digestive Manifestations in Patients Hospitalized with COVID-19

BackgroundThe prevalence and significance of digestive manifestations in COVID-19 remain uncertain. MethodsConsecutive patients hospitalized with COVID-19 were identified across a geographically diverse alliance of medical centers in North America. Data pertaining to baseline characteristics, symptomatology, laboratory assessment, imaging, and endoscopic findings from the time of symptom onset until discharge or death were manually abstracted from electronic health records to characterize the prevalence, spectrum, and severity of digestive manifestations. Regression analyses were performed to evaluate the association between digestive manifestations and severe outcomes related to COVID-19. ResultsA total of 1992 patients across 36 centers met eligibility criteria and were included. Overall, 53% of patients experienced at least one gastrointestinal symptom at any time during their illness, most commonly diarrhea (34%), nausea (27%), vomiting (16%), and abdominal pain (11%). In 74% of cases, gastrointestinal symptoms were judged to be mild. In total, 35% of patients developed an abnormal alanine aminotransferase or total bilirubin level; these were elevated to less than 5 times the upper limit of normal in 77% of cases. After adjusting for potential confounders, the presence of gastrointestinal symptoms at any time (odds ratio 0.93, 95% confidence interval 0.76-1.15) or liver test abnormalities on admission (odds ratio 1.31, 95% confidence interval 0.80-2.12) were not independently associated with mechanical ventilation or death. ConclusionsAmong patients hospitalized with COVID-19, gastrointestinal symptoms and liver test abnormalities were common but the majority were mild and their presence was not associated with a more severe clinical course

Correction to: Role of identified bacterial consortium in treatment of Quhafa wastewater treatment plant influent in Fayuom, Egypt.

The original version of this article unfortunately contained an error.

Role of identified bacterial consortium in treatment of Quhafa Wastewater Treatment Plant influent in Fayuom, Egypt.

This study was aimed to biologically treat domestic wastewater using identified bacterial consortium for chemical pollutants removal by treating/passing it through sand biofilters. The identification, toxicity test, and the optimum dose of the investigated bacterial consortium were carried out using Microtox analyzer and Batch biological treatment, respectively. Furthermore, application of sedimentation followed by gravel and sand biofilters for wastewater treatment was evaluated. The results showed that the bacterial consortium is composed of Pediococcus acidilactici, Pediococcus pentosaceus, Lactobacillus plantarum, and Bacillus subtilis. The optimum dose for wastewater treatment within 6 h of contact time is 2.5 mg/L, this dose (2.5 mg/L) has no toxic effect. The removal percentage of chemical oxygen demand (COD), biological oxygen demand (BOD), total solids (TS), total dissolved solids (TDS), total suspended solids (TSS), ammonia, nitrate, total Kjeldahl nitrogen (TKN), and oil and grease reached 93.4, 83.5, 37.5, 49.2, 93.4, 100, 55.7, 76.6, and 76% in the effluent of the treated wastewater, respectively after the third sand biofilter filtration. It can be concluded that using bacterial consortium for domestic wastewater treatment could be a good tool for chemical pollutants removal. Moreover, this study provides low cost and eco-friendly tool for domestic wastewater treatment using simple multistage biofilters based on an identified bacterial consortium. This system can be upscaled for the treatment of larger volumes of wastewater.

Metagenomics analysis of bacterial structure communities within natural biofilm.

The bacterial profiles of natural household biofilm have not been widely investigated. The majorities of these bacterial lineages are not cultivable. Thus, this study aims (i) to enumerate some potential bacterial lineages using culture based method within biofilm samples and confirmed using Biolog GEN III and polymerase chain reaction (PCR). (ii) To investigate the bacterial profiles of communities in two biofilm samples using next generation sequencing (NGS). Forty biofilm samples were cultured and colonies of each selected prevailing potential lineages (E. coli, Salmonella entrica, Pseudomonas aeruginosa, Staphylococcus aureus and Listeria monocytogenes) were selected for confirmation. From obtained results, the counts of the tested bacterial lineages in kitchen biofilm samples were greater than those in bathroom samples. Precision of PCR was higher than Biolog GEN III to confirm the bacterial isolates. Using NGS analysis, the results revealed that a total of 110,554 operational taxonomic units (OTUs) were obtained for two biofilm samples, representing kitchen and bathroom biofilm samples. The numbers of phyla in the kitchen biofilm sample (35 OTUs) was higher than that in bathroom sample (18 OTUs). A total of 435 genera were observed in the bathroom biofilm sample compared to only 256 in the kitchen sample. Evidences have shown that the empirical gadgets for biofilm investigation are becoming convenient and affordable. Many distinct bacterial lineages observed in biofilm are one of the most significant issues that threaten human health and lead to disease outbreaks.

Synthesis of novel chitosan-PVC conjugates encompassing Ag nanoparticles as antibacterial polymers for biomedical applications.

We herein describe the synthesis of four Cs-PVC conjugates three of them were functionalized with benzothiazole (BTh) derivative as an antibacterial agent. Two of these BTh-functionalized conjugates, namely Cs2 and Cs3, comprise silver nanoparticles (AgNPs) and Ag/TiO2 NPs, respectively. The structures were characterized via FTIR spectroscopic analysis, morphological investigation such as scanning (SEM) and transmission (TEM) electron microscopy, and thermal gravimetric analysis (TGA). Spectral data confirmed the introduction of the BTh to the Cs backbone as well as the coupling between the two polymers. SEM data showed homogenous polymer surfaces with well-distributed Ag nanoparticles. The Ag contents in the prepared samples Cs2 and Cs3 were, respectively, 0.61 and 0.21%, however, TEM analysis showed that the sizes of AgNPs and Ag/TiO2 NPs were in the range of 3-7 nm and 15-22 nm for the prepared conjugates, respectively. The antibacterial activity of the synthesized conjugates was investigated against two Gram-negative (E. coli, and S. typhimurium) and two Gram-positive (S. aureus, and L. monocytogenes) bacteria. The antibacterial assay showed that all three Cs-PVC (Cs1, Cs2, and Cs3) conjugates modified with BTh exhibited excellent bacterial inhibition after 30, 60, and 120 min.

Survival of E. coli O157:H7, Salmonella Typhimurium, HAdV2 and MNV-1 in river water under dark conditions and varying storage temperatures.

The ability of Escherichia coli O157:H7, Salmonella enterica serovar Typhimurium, Human adenovirus serotype 2 (HAdV2) and Murine Norovirus 1 (MNV-1) to survive in river water at -20, 4, room temperature (~24 °C) and 37 °C, were evaluated under dark conditions. The tested surface water was obtained from the main Nile River in the Dokki area, Giza and sterilized by autoclaving. The pathogens were inoculated separately in the autoclaved river water. Each microcosm was sampled and the test microorganisms counted after zero (immediately following inoculation), 1, 7, 15, 30, 60, 90 and 120 days. Physicochemical parameters including pH, turbidity, electrical conductivity, dissolved oxygen, total dissolved solids, total alkalinity, biological oxygen demand, chemical oxygen demand, nitrates and nitrites, and sulphate, were also measured. For HAdV2, the highest decay rates were observed at 37 °C and room temperature compared to 4 and -20 °C. A similar trend was found for the MNV-1, although unlike the HAdV2, the decay rate was higher at -20 than at 4 °C. Also, 4 °C was the best temperature for the survival of MNV-1 (T90 = 76.9 days), E. coli O157:H7 (T90 = 103 days) and Salmonella Typhimurium (T90 = 105 days). The least survival of the pathogens, except MNV-1, was recorded at 37 °C. These results indicate that under dark conditions and low temperatures, enteric pathogens could be stable for extended periods. No significant statistical correlation was observed between the experimental temperatures and the infectivity of the viral particles. This study provided useful information about the stability of these pathogens in the Nile River water and could serve as an early warning when considering the water of the river for agricultural irrigation or household use in areas with limited or no access to potable water.

Facile synthesis of magnetic disinfectant immobilized with silver ions for water pathogenic microorganism's deactivation.

One-pot synthesis of a new magnetic disinfectant was achieved through the polymerization of thiourea and formaldehyde in the presence of magnetite nanoparticles (MTUF). The obtained magnetic chelating resin was loaded with Ag(I) ions. This material was tested as a disinfectant for water pathogenic microorganism's deactivation. The toxicity of MTUF before and after Ag(I) loading was estimated. The antimicrobial activity tests of MTUF-Ag were carried out against Escherichia coli, Salmonella Typhimurium, and Pseudomonas aeruginosa as examples of Gram-negative bacteria; Listeria monocytogenes, Staphylococcus aureus, Enterococcus faecalis, and Bacillus subtilis as examples of Gram-positive bacteria; and Candida albicans as representative for fungi. The results showed that the minimum inhibitory dosage (MID) of MTF-Ag against Escherichia coli, Salmonella Typhimurium, Listeria monocytogenes, Staphylococcus aureus, and mixed culture were 1.5, 2.0, 1.0, 1.5, and 1.5 mg/mL, respectively, after 40 min of contact time. While C. albicans was more resistant to the magnetic disinfectant, only three log reductions were done at 2.5 mg/mL. The studied MTUF-Ag was successfully tested for water and wastewater pathogenic microorganism's deactivation. It can be concluded that MTUF-Ag could be a good candidate for water disinfection.

Comparison of the Hospital-Acquired Clostridium difficile Infection Risk of Using Proton Pump Inhibitors versus Histamine-2 Receptor Antagonists for Prophylaxis and Treatment of Stress Ulcers: A Systematic Review and Meta-Analysis

BACKGROUND/AIMS: Although proton pump inhibitors (PPIs) have been widely used for the prevention and treatment of stress gastric ulcers in hospital settings, there are concerns that PPIs increase the risk of Clostridium difficile infection (CDI). However, little is known about the risk of CDI following PPI and histamine-2 receptor antagonist (H2RA) use. We evaluated the comparative hospital-acquired CDI occurrence risk associated with the concurrent use of PPIs versus H2RAs. METHODS: A systematic search of PubMed, MEDLINE/Ovid, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, and Google Scholar through August 19, 2016, identified 12 studies that reported the hospital-acquired CDI occurrence following H2RA and PPI use for the prevention and treatment of stress gastric ulcers. Random-effects pooled odds ratios and 95% confidence intervals were estimated. Heterogeneity was measured using I², and a meta-regression analysis was conducted. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system was used to assess the overall quality of the evidence. RESULTS: A total of 74,132 patients from 12 observational studies were analyzed. Compared to H2RAs, PPIs increased the risk of CDI by 38.6% (pooled odds ratio, 1.386; 95% confidence interval, 1.152 to 1.668; p=0.001; I²=42.81%). Subgroup analyses of the purpose of study medication use, study site, and study design confirmed the consistency of a greater CDI risk with PPIs than with H2RAs. The overall quality of evidence was rated as low. CONCLUSIONS: The use of PPIs for both the prevention and treatment of stress ulcers was associated with a 38.6% increased risk of hospital-acquired CDI occurrence compared to H2RA use.