Incidence of Campylobacter and Salmonella Infections Following First Prescription for PPI: A Cohort Study Using Routine Data
Incidence of Campylobacter and Salmonella Infections Following First Prescription for PPI: A Cohort Study Using Routine Data
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DOI：
10.1038/ajg.2013.30
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发表时间：
2013-07-01
影响因子：
9.8
通讯作者：
Dunstan, Frank
中科院分区：
文献类型：
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作者：
Brophy, Sinead;Jones, Kerina H.;Dunstan, Frank
目的：与对照组相比，检查服用质子泵抑制剂 (PPI) 的患者中弯曲杆菌和沙门氏菌感染的发生率。方法：使用匿名全科医生 (GP) 数据进行回顾性队列研究。选择了 1990 年至 2010 年威尔士安全匿名信息链接 (SAIL) 系统中的匿名个人记录。数据来自 1,913,925 人，其中 358,938 人服用了 PPI。检查的主要结果指标包括服用 PPI 处方后弯曲杆菌或沙门氏菌感染的发生率。结果：甚至在 PPI 处方之前，弯曲杆菌和沙门氏菌感染率就已经是非 PPI 患者的 3.1-6.9 倍。与基线相比，PPI 组的弯曲杆菌感染风险率（在处方 PPI 后）增加了 1.46，沙门氏菌感染风险率增加了 1.2。然而，非 PPI 患者的风险比也随着时间的推移而增加。事实上，使用既往事件发生率比，PPI 组与非 PPI 组的事件比率为：弯曲杆菌为 1.17 (95 % CI 0.74-1.61)，沙门氏菌为 1.00 (0.5-1.5)。 结论：继续服用 PPI 的人事先发生胃肠道 (GI) 感染的潜在风险更大，并且在 PPI 前危险因素的患病率更高处方。无论是否使用 PPI，感染的诊断率都会随着时间的推移而增加，并且没有证据表明 PPI 与诊断出的胃肠道感染的增加有关。与患者人口统计学相关的因素很可能是导致服用 PPI 的患者胃肠道感染率增加的主要原因。
OBJECTIVES : To examine the incidence of Campylobacter and Salmonella infection in patients prescribed proton pump inhibitors (PPIs) compared with controls.METHODS: Retrospective cohort study using anonymous general practitioner (GP) data. Anonymised individual-level records from the Secure Anonymised Information Linkage (SAIL) system between 1990 and 2010 in Wales were selected. Data were available from 1,913,925 individuals including 358,938 prescribed a PPI. The main outcome measures examined included incidence of Campylobacter or Salmonella infection following a prescription for PPI.RESULTS: The rate of Campylobacter and Salmonella infections was already at 3.1-6.9 times that of non-PPI patients even before PPI prescription. The PPI group had an increased hazard rate of infection (after prescription for PPI) of 1.46 for Campylobacter and 1.2 for Salmonella, compared with baseline. However, the non-PPI patients also had an increased hazard ratio with time. In fact, the ratio of events in the PPI group compared with the non-PPI group using the prior event rate ratio was 1.17 (95 % CI 0.74-1.61) for Campylobacter and 1.00 (0.5-1.5) for Salmonella.CONCLUSIONS: People who go on to be prescribed PPIs have a greater underlying risk of gastrointestinal (GI) infection beforehand and they have a higher prevalence of risk factors before PPI prescription. The rate of diagnosis of infection is increasing with time regardless of PPI use, and there is no evidence that PPI is associated with an increase in diagnosed GI infection. It is likely that factors associated with the demographic profile of the patient are the main contributors to increased rate of GI infection for patients prescribed PPIs.