Emergence of fluoroquinolones as the predominant risk factor for Clostridium difficile-associated diarrhea:: A cohort study during an epidemic in Quebec
Emergence of fluoroquinolones as the predominant risk factor for Clostridium difficile-associated diarrhea:: A cohort study during an epidemic in Quebec
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DOI：
10.1086/496986
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发表时间：
2005-11-01
影响因子：
11.8
通讯作者：
Lanthier, L
中科院分区：
文献类型：
--
作者：
Pépin, J;Saheb, N;Lanthier, L
背景自2002年以来，艰难梭菌相关性腹泻（CDAD）的流行与高病死率有关，涉及加拿大魁北克省的130家医院。2003年，在我院共有55%的CDAD患者在前2个月内接受过氟喹诺酮类药物治疗。有人认为，大量使用质子泵抑制剂可能促进了这一药物。为了描述与特定类别抗生素相关的CDAD的风险，以及是否通过同时使用质子泵抑制剂和其他改变胃酸或胃肠动力的药物来调节，我们对2003年1月至2004年6月期间在加拿大Sherbrooke的一家教学医院住院的患者进行了一项回顾性队列研究。我们获得了7421次护理对应的5619个人的数据。观察患者直至其发生CDAD或死亡或出院后60天。采用考克斯回归法计算校正的风险比（AHR）。293例患者发生CDAD。氟喹诺酮类抗生素与CDAD的相关性最强（AHR，3.44; 95%置信区间[CI]，2.65-4.47）。几乎四分之一的住院患者接受喹诺酮类药物治疗，其中CDAD的人群归因分数为35.9%。所有3代头孢菌素、大环内酯类、克林霉素和静脉注射β-内酰胺/β-内酰胺酶抑制剂均为中等风险抗生素，AHR相似（1.56-1.89）。质子泵抑制剂（AHR，1.00，95%CI，0.79-1.28）与CDAD无关。在魁北克，在一次由C.很难
Background. Since 2002, an epidemic of Clostridium difficile-associated-diarrhea (CDAD) associated with a high case-fatality rate has involved 130 hospitals in the province of Quebec, Canada. In 2003, a total of 55% of patients with CDAD at our hospital had received fluoroquinolones in the preceding 2 months. It has been suggested that massive use of proton pump inhibitors might have facilitated this epidemic.Methods. To delineate the risk of CDAD associated with specific classes of antibiotics and whether this is modulated by concomitant use of proton pump inhibitors and other drugs altering gastric acidity or gastrointestinal motility, we conducted a retrospective cohort study of patients hospitalized in a teaching hospital in Sherbrooke, Canada, during the period of January 2003 through June 2004. We obtained data on 7421 episodes of care corresponding to 5619 individuals. Patients were observed until they either developed CDAD or died or for 60 days after discharge from the hospital. Adjusted hazard ratios (AHRs) were calculated using Cox regression.Results. CDAD occurred in 293 patients. Fluoroquinolones were the antibiotics most strongly associated with CDAD (AHR, 3.44; 95% confidence interval [CI], 2.65-4.47). Almost one-fourth of all inpatients received quinolones, for which the population-attributable fraction of CDAD was 35.9%. All 3 generations of cephalosporins, macrolides, clindamycin, and intravenous beta-lactam/beta-lactamase inhibitors were intermediate-risk antibiotics, with similar AHRs (1.56-1.89). Proton pump inhibitors (AHR, 1.00, 95% CI, 0.79-1.28) were not associated with CDAD.Conclusions. Administration of fluoroquinolones emerged as the most important risk factor for CDAD in Quebec during an epidemic caused by a hypervirulent strain of C. difficile.