Predicting Clostridium difficile infection in diabetic patients and the effect of metformin therapy: a retrospective, case-control study
Predicting Clostridium difficile infection in diabetic patients and the effect of metformin therapy: a retrospective, case-control study
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DOI：
10.1007/s10096-015-2348-3
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发表时间：
2015-06-01
影响因子：
4.5
通讯作者：
Bishara, J.
中科院分区：
文献类型：
--
作者：
Eliakim-Raz, N.;Fishman, G.;Bishara, J.
关于糖尿病患者艰难梭菌感染（CDI）的危险因素的数据很少。最近，研究表明二甲双胍可增加拟杆菌/厚壁菌的比例;因此，二甲双胍可能对CDI产生保护作用。我们的目的是评估抗生素治疗以外的糖尿病患者发生CDI的危险因素，并确定二甲双胍治疗对这些患者发生CDI的影响。在这项回顾性病例对照研究中，纳入了2009年1月至2013年12月的所有连续CDI糖尿病患者，并与同期在相同科室住院的连续无CDI糖尿病患者进行了比较。在7,670名接受C.艰难毒素，486人是糖尿病患者。其中150例（30.8%）为C.艰难梭菌毒素和336（69.1%）是阴性的。在多变量分析中，二甲双胍治疗与CDI显著降低相关[比值比（OR）= 0.58; 95%置信区间（CI），0.37-0.93; p = 0.023]，而心力衰竭与CDI显著升高相关（OR = 1.654; 95% CI，1.007-2.716; p = 0.047），以及功能状态差、既往住院和腹部手术。我们的研究结果表明，在糖尿病患者中，除了公认的风险因素外，心力衰竭是CDI的额外风险因素，而二甲双胍治疗似乎对CDI的发展具有保护作用。这种保护作用的确切机制仍有待充分理解。
Data on risk factors for Clostridium difficile infection (CDI) in diabetic patients are scarce. Recently, it has been shown that metformin increases the Bacteroidetes/Firmicutes ratio; therefore, it may yield a protective effect against CDI. We aimed to assess risk factors for CDI in diabetic patients beyond antibiotic treatment, and to determine the impact of metformin therapy on the development of CDI in these patients. In this retrospective, case-control study, all consecutive CDI diabetic patients, from January 2009 to December 2013, were included and compared to consecutive diabetic patients without CDI, hospitalized during the same period and in the same departments. Of 7,670 patients tested for C. difficile toxins, 486 were diabetics. Of them, 150 (30.8 %) were positive for C. difficile toxins and 336 (69.1 %) were negative. On multivariate analysis, metformin treatment was associated with a significant reduction in CDI [odds ratio (OR) = 0.58; 95 % confidence interval (CI), 0.37-0.93; p = 0.023], while heart failure was associated with significantly higher rates of CDI (OR = 1.654; 95 % CI, 1.007-2.716; p = 0.047), together with poor functional status, previous hospitalization, and abdominal surgery. Our findings suggest that, in diabetic patients, in addition to the well-recognized risk factors, heart failure is an additional risk factor for CDI, while metformin treatment seems to have a protective effect against the development of CDI. The exact mechanisms underlying this protective effect remain to be fully understood.