Gastric Acid Suppression by Proton Pump Inhibitors as a Risk Factor for Clostridium difficile-Associated Diarrhea in Hospitalized Patients
Gastric Acid Suppression by Proton Pump Inhibitors as a Risk Factor for Clostridium difficile-Associated Diarrhea in Hospitalized Patients
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DOI：
10.1111/j.1572-0241.2008.01975.x
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发表时间：
2008-09-01
影响因子：
9.8
通讯作者：
Zackula, Rosalee
中科院分区：
文献类型：
--
作者：
Aseeri, Mohammed;Schroeder, Todd;Zackula, Rosalee
背景：艰难梭菌（C。艰难梭菌）和质子泵抑制剂（PPI）的使用尚不清楚。本研究调查艰难梭菌相关性腹泻（CDAD）和暴露于抑酸治疗的住院成人patients.METHODS：一项回顾性病例对照研究，同时控制最常见的诱发危险因素之间的关系进行了当地医院的所有住院患者在2005年10月1日和2006年9月30日之间发展CDAD住院期间。如果C阳性，则确定受试者患有CDAD。艰难梭菌毒素与诊断时腹泻的临床相关性。受试者与对照组在以下因素上配对：入院日期、抗生素暴露、性别、年龄组、患者所在地（内科或外科）和入院时的房间类型。七个危险因素进行了评估与发病的CDAD：暴露于PPI或H-2受体阻滞剂，肾功能衰竭，糖尿病，免疫抑制，恶性肿瘤和胃肠道疾病。住院期间，病例组比对照组更可能接受抑酸治疗，分别为72例（76.6%）和40例（42.6%），P = 0.030。在多变量精确条件Logistic回归分析中，CDAD与PPI的使用相关（比值比[OR] = 3.6，95%置信区间[Cl] = 1.7-8.3; P < 0.001），并伴有肾功能衰竭结论：本研究显示，在接受抑酸治疗的住院患者中，发生CDAD的风险增加，尤其是在使用PPI时。
BACKGROUND: Evidence for the association between Clostridium difficile (C. difficile) and the use of proton pump inhibitor (PPI) is unclear. This study investigated the relationship between Clostridium difficile-associated diarrhea (CDAD) and exposure to acid suppressive therapy in hospitalized adult patients while controlling for the most common predisposing risk factors.METHODS: A retrospective case-control study was conducted at a local hospital of all hospitalized patients between October 1, 2005 and September 30, 2006 who developed CDAD during hospitalization. Subjects were determined to have CDAD if there was a positive C. difficile toxin and clinical correlation of diarrhea at the time of diagnosis. Subjects were pair-matched to controls on the following factors: admission date, antibiotic exposure, gender, age groups, patient location (medical or surgical unit), and room type at time of admission. Seven risk factors were assessed for association with onset of CDAD: exposure to PPIs or H-2-blockers, renal failure, diabetes mellitus, immunosuppression, malignancy, and gastrointestinal disease.RESULTS: Ninety-four cases were successfully matched to controls. Cases were more likely than controls to receive acid suppressive therapy during hospitalization, 72 (76.6%) versus 40 (42.6%), respectively, P = 0.030. In a multivariate exact conditional logistic regression analysis, CDAD was associated with use of PPI (odds ratio [OR] = 3.6, 95% confidence interval [Cl] = 1.7-8.3; P < 0.001), and with renal failure (OR = 5.7, Cl = 1.3-39.1; P = 0.02).CONCLUSION: This study showed elevated risk of developing CDAD in hospitalized patients with acid suppressive therapy, especially when PPIs were used.