Department of Pediatrics, F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD.
Department of Pediatrics, F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD.
J Pediatr. 2014 Nov;165(5):979-84.e1. doi: 10.1016/j.jpeds.2014.06.062. Epub 2014 Aug 8.
Multiple studies have confirmed associations between acid suppression medication and Clostridium difficile infections (CDIs) in adults. Therefore, we sought to evaluate an association between acid suppression medications and CDI in children.
A retrospective self-controlled case series was performed utilizing billing records from the TRICARE Management Activity military health system database. Children ages 2-18 years from October 1, 2001 to July 31, 2013, who had an outpatient or inpatient record of CDI diagnosis were included. The relative incidences (RIs) of CDI or recurrent CDI were calculated comparing time periods prescribed and not prescribed proton pump inhibitors (PPIs) or histamine-2 receptor antagonists (H2RAs).
There were 2531 cases of CDI among 2437 patients, and 1190 (48.8%) were prescribed acid suppression medications. CDI were more likely to occur during periods when patients were prescribed a PPI (RI 2.36; 95% CI 2.22-2.52), H2RA (RI 1.95; 95% CI 1.63-2.34), or during periods while prescribed both simultaneously (RI 2.40; 95% CI 1.90-3.04). There were 265 (10.4%) cases that were classified as recurrent among 217 (8.9%) patients. Recurrent CDI also was found to be more likely during prescription periods of PPI (RI 1.74; 95% CI 1.51-2.00) and H2RA (RI 2.63; 95% CI 1.89-3.66).
Acid suppression medications are associated with an increased risk of CDI and recurrent CDI. Judicious use of acid suppression medication should be considered, especially among those at highest risk for CDI.
多项研究已证实抑酸药物与成人艰难梭菌感染（CDI）之间存在关联。因此，我们试图评估抑酸药物与儿童 CDI 之间的关联。
本研究采用 TRICARE 管理活动军事医疗系统数据库的计费记录，进行了回顾性自身对照病例系列研究。纳入 2001 年 10 月 1 日至 2013 年 7 月 31 日期间，年龄在 2-18 岁之间、门诊或住院记录有 CDI 诊断的患儿。比较了处方质子泵抑制剂（PPIs）或组胺 2 受体拮抗剂（H2RAs）与未处方时的 CDI 或复发性 CDI 的相对发病率（RI）。
在 2437 例患儿中，有 2531 例 CDI，其中 1190 例（48.8%）处方了抑酸药物。当患儿同时处方 PPI（RI 2.36；95%CI 2.22-2.52）、H2RA（RI 1.95；95%CI 1.63-2.34）或同时处方两者时，CDI 更易发生（RI 2.40；95%CI 1.90-3.04）。在 217 例（8.9%）患儿中，有 265 例（10.4%）被归类为复发性 CDI。同样发现，在 PPI 处方期间（RI 1.74；95%CI 1.51-2.00）和 H2RA 处方期间（RI 2.63；95%CI 1.89-3.66），复发性 CDI 更易发生。
抑酸药物与 CDI 和复发性 CDI 的风险增加相关。应慎重使用抑酸药物，尤其是在 CDI 风险最高的人群中。
