Dial Sandra, Delaney J A C, Barkun Alan N, Suissa Samy
Division of Critical Care and Respiratory and Clinical Research, Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec.
JAMA. 2005 Dec 21;294(23):2989-95. doi: 10.1001/jama.294.23.2989.
Recent reports suggest an increasing occurrence and severity of Clostridium difficile-associated disease. We assessed whether the use of gastric acid-suppressive agents is associated with an increased risk in the community.
To determine whether the use of gastric acid-suppressive agents increases the risk of C difficile-associated disease in a community population.
DESIGN, SETTING, AND PATIENTS: We conducted 2 population-based case-control studies using the United Kingdom General Practice Research Database (GPRD). In the first study, we identified all 1672 cases of C difficile recorded between 1994 and 2004 among all patients registered for at least 2 years in each practice. Each case was matched to 10 controls on calendar time and the general practice. In the second study, a subset of these cases defined as community-acquired, that is, not hospitalized in the prior year, were matched on practice and age with controls also not hospitalized in the prior year.
The incidence of C difficile and risk associated with gastric acid-suppressive agent use.
The incidence of C difficile in patients diagnosed by their general practitioners in the General Practice Research Database increased from less than 1 case per 100,000 in 1994 to 22 per 100,000 in 2004. The adjusted rate ratio of C difficile-associated disease with current use of proton pump inhibitors was 2.9 (95% confidence interval [CI], 2.4-3.4) and with H2-receptor antagonists the rate ratio was 2.0 (95% CI, 1.6-2.7). An elevated rate was also found with the use of nonsteroidal anti-inflammatory drugs (rate ratio, 1.3; 95% CI, 1.2-1.5).
The use of acid-suppressive therapy, particularly proton pump inhibitors, is associated with an increased risk of community-acquired C difficile. The unexpected increase in risk with nonsteroidal anti-inflammatory drug use should be investigated further.
最近的报告显示，艰难梭菌相关疾病的发生率和严重程度在不断增加。我们评估了在社区中使用胃酸抑制剂是否会增加患病风险。
确定在社区人群中使用胃酸抑制剂是否会增加患艰难梭菌相关疾病的风险。
设计、研究地点和患者：我们利用英国全科医学研究数据库（GPRD）开展了两项基于人群的病例对照研究。在第一项研究中，我们在每个诊所登记至少两年的所有患者中，确定了1994年至2004年间记录的所有1672例艰难梭菌病例。每个病例在日历时间和全科诊所方面与10名对照进行匹配。在第二项研究中，将这些病例中的一部分定义为社区获得性病例，即前一年未住院的病例，在诊所和年龄方面与同样前一年未住院的对照进行匹配。
艰难梭菌的发病率以及与使用胃酸抑制剂相关的风险。
在全科医学研究数据库中，由全科医生诊断的患者中，艰难梭菌的发病率从1994年的每10万人不到1例增加到2004年的每10万人22例。当前使用质子泵抑制剂时，艰难梭菌相关疾病的校正率比为2.9（95%置信区间[CI]，2.4 - 3.4），使用H2受体拮抗剂时，率比为2.0（95%CI，1.6 - 2.7）。使用非甾体抗炎药时也发现发病率升高（率比，1.3；95%CI，1.2 - 1.5）。
使用抑酸疗法，尤其是质子泵抑制剂，与社区获得性艰难梭菌风险增加相关。非甾体抗炎药使用风险的意外增加应进一步研究。
