Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, USA.
Mayo Clin Proc. 2012 Jul;87(7):636-42. doi: 10.1016/j.mayocp.2011.12.021.
To evaluate the association of gastric acid suppression medications, including proton pump inhibitors and histamine type 2 blockers, with outcomes in patients with Clostridium difficile infection (CDI) in a population-based cohort.
To understand the association between acid suppression and outcomes in patients with CDI, we conducted a population-based study in Olmsted County, Minnesota, from January 1, 1991, through December 31, 2005. We compared demographic data and outcomes, including severe, severe-complicated, and recurrent CDI and treatment failure, in a cohort of patients with CDI who were treated with acid suppression medications with these outcomes in a cohort with CDI that was not exposed to acid-suppressing agents.
Of 385 patients with CDI, 36.4% were undergoing acid suppression (23.4% with proton pump inhibitors, 13.5% with histamine type 2 blockers, and 0.5% with both). On univariate analysis, patients taking acid suppression medications were significantly older (69 vs 56 years; P<.001) and more likely to have severe (34.2% vs 23.6%; P=.03) or severe-complicated (4.4% vs 2.6% CDI; P=.006) infection than patients not undergoing acid suppression. On multivariable analyses, after adjustment for age and comorbid conditions, acid suppression medication use was not associated with severe or severe-complicated CDI. In addition, no association between acid suppression and treatment failure or CDI recurrence was found.
In this population-based study, after adjustment for age and comorbid conditions, patients with CDI who underwent acid suppression were not more likely to experience severe or severe-complicated CDI, treatment failure, or recurrent infection.
在基于人群的队列中评估胃酸抑制药物（包括质子泵抑制剂和 H2 受体阻滞剂）与艰难梭菌感染（CDI）患者结局的相关性。
为了了解胃酸抑制与 CDI 患者结局之间的关系，我们在明尼苏达州奥姆斯特德县进行了一项基于人群的研究，时间为 1991 年 1 月 1 日至 2005 年 12 月 31 日。我们比较了 CDI 患者接受胃酸抑制药物治疗的队列与未接受酸抑制药物治疗的 CDI 队列的人口统计学数据和结局，包括严重、严重并发症和复发性 CDI 以及治疗失败。
在 385 例 CDI 患者中，36.4%正在接受胃酸抑制治疗（质子泵抑制剂 23.4%，H2 受体阻滞剂 13.5%，两者均为 0.5%）。单因素分析显示，接受胃酸抑制治疗的患者年龄明显较大（69 岁 vs. 56 岁；P<.001），且更有可能发生严重（34.2% vs. 23.6%；P=.03）或严重并发症（4.4% vs. 2.6% CDI；P=.006）感染。多变量分析显示，在校正年龄和合并症后，胃酸抑制药物的使用与严重或严重并发症 CDI 无关。此外，也未发现胃酸抑制与治疗失败或 CDI 复发之间存在关联。
在这项基于人群的研究中，在校正年龄和合并症后，接受胃酸抑制治疗的 CDI 患者发生严重或严重并发症 CDI、治疗失败或复发性感染的可能性并不更高。
