Immunosuppression and Clostridioides (Clostridium) difficile Infection Risk in Metabolic and Bariatric Surgery Patients.
Immunosuppression and Clostridioides (Clostridium) difficile Infection Risk in Metabolic and Bariatric Surgery Patients.
复制标题
DOI：
10.1016/j.jamcollsurg.2021.04.028
复制
发表时间：
2021-08
影响因子：
5.2
通讯作者：
Messiah SE
中科院分区：
文献类型：
--
作者：
Morales-Marroquin E;Xie L;Uppuluri M;Almandoz JP;Cruz-Muñoz N;Messiah SE
免疫抑制剂的使用会增加艰难梭菌感染的风险。迄今为止，还没有研究分析免疫抑制剂的使用与代谢和减肥手术后艰难梭菌感染之间的关系。对 2015-2018 年代谢和减肥手术认证和质量改进计划 (MBSAQIP) 数据进行了回顾性分析。 MBSAQIP 数据包括来自美国和加拿大 854 家附属机构的信息。初始样本量为 760,076 MBS 患者。由于缺失变量 (n= 188,106) 和使用除 Roux-en-Y 胃绕道术和袖状胃成形术 (n=129,712) 以外的外科手术而排除参与者后，对 442,258 名参与者进行了最终分析。逻辑回归模型根据免疫抑制剂状态生成 MBS 后艰难梭菌感染的几率 (+/-)。未经调整的逻辑回归分析显示，与未服用免疫抑制剂的 MBS 患者相比，使用免疫抑制剂的患者术后发生艰难梭菌感染的可能性高出 95%（OR=1.945，95% CI=1.230 至 3.075；p <0.001）。调整年龄、性别、种族、术前 BMI、糖尿病状况和手术类型后，该关联未受影响（aOR=1.956，95% CI=1.236 至 3.095；p <0.01）。与完成腹腔镜袖状胃切除术的患者相比，完成腹腔镜 Roux-en-Y 胃绕道手术的患者发生艰难梭菌感染的几率是其两倍多（OR=2.183，95% CI=1.842 至 2.587；p < 0.0001）。我们使用基于人群的 MBS 患者样本得出的结果表明，服用免疫抑制剂的患者术后发生艰难梭菌感染的风险显着更高。这些发现表明，应在术前和术后密切监测使用免疫抑制剂的患者。这项研究首次表明，与接受手术但未服用免疫抑制剂的患者相比，免疫抑制剂会使代谢和减肥手术后艰难梭菌感染风险增加 95%。需要更多地关注服用免疫抑制剂的代谢和减肥手术患者。
Immunosuppressant use increases the risk of Clostridioides difficile infection. To date no studies have analyzed the relationship between immunosuppressant use and Clostridioides difficile infections after metabolic and bariatric surgery. A retrospective analysis of the 2015–2018 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) data was conducted. The MBSAQIP data includes information from 854 affiliated practices in the United States and Canada. Initial sample size was 760,076 MBS patients. After excluding participants due to missing variables (n= 188,106) and the use of surgical procedures other than Roux-en-Y gastric bypass and sleeve gastroplasty (n=129,712), final analyses were performed on 442,258 participants. Logistic regression models generated the odds of post-MBS Clostridioides difficile infection by immunosuppressant status (+/−). Unadjusted logistic regression analysis showed that patients using immunosuppressants were 95% more likely to have post-operative Clostridioides difficile infection (OR=1.945, 95% CI= 1.230 to 3.075; p <0.001) versus MBS patients not taking immunosuppressants. After adjusting for age, gender, ethnicity, pre-operative BMI, diabetes status, and surgery procedure type, the association remained unaffected (aOR=1.956, 95% CI=1.236 to 3.095; p <0.01). Patients who completed the laparoscopic Roux-en-Y gastric bypass procedure had more than double the odds of developing Clostridioides difficile infection compared to those who completed the laparoscopic sleeve gastrectomy procedure (OR=2.183, 95% CI=1.842 to 2.587; p < 0.0001). Our results using a population-based sample of MBS patients show that those taking immunosuppressants have significantly higher risk of developing Clostridioides difficile infection post-operatively. These findings suggest that patients using immunosuppressants should be closely monitored both pre- and post-procedure. This study showed for the first time that immunosuppressant increased postmetabolic and bariatric surgery Clostridioides difficile infection risk by 95% in comparison with patients who also underwent operation but were not consuming immunosuppressant. Increased attention to metabolic and bariatric surgery patients taking immunosuppressant is needed.
登录
查看更多内容
美国梭菌艰难梭菌感染和结果负担的趋势。
DOI：
10.1056/nejmoa1910215
发表时间：
2020-04-02
期刊：
The New England journal of medicine
影响因子：
--
作者：
Guh AY;Mu Y;Winston LG;Johnston H;Olson D;Farley MM;Wilson LE;Holzbauer SM;Phipps EC;Dumyati GK;Beldavs ZG;Kainer MA;Karlsson M;Gerding DN;McDonald LC;Emerging Infections Program Clostridioides difficile Infection Working Group
通讯作者：
Emerging Infections Program Clostridioides difficile Infection Working Group
DOI：
10.1007/s10096-015-2348-3
发表时间：
2015-06-01
影响因子：
4.5
作者：
Eliakim-Raz, N.;Fishman, G.;Bishara, J.
通讯作者：
Bishara, J.
影响因子：
8.4
作者：
Avni, Tomer;Babitch, Tanya;Bishara, Jihad
通讯作者：
Bishara, Jihad
影响因子：
3.1
作者：
Albright, Jeffrey B.;Bonatti, Hugo;Hellinger, Walter
通讯作者：
Hellinger, Walter
影响因子：
3.1
作者：
Farin, William;Onate, Florian Plaza;Ehrlich, S. Dusko
通讯作者：
Ehrlich, S. Dusko