Department of Internal Medicine, University of Nevada School of Medicine, Las Vegas, NV, USA.
Department of Global Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
Gut Liver. 2017 Nov 15;11(6):781-788. doi: 10.5009/gnl16568.
BACKGROUND/AIMS: Although proton pump inhibitors (PPIs) have been widely used for the prevention and treatment of stress gastric ulcers in hospital settings, there are concerns that PPIs increase the risk of infection (CDI). However, little is known about the risk of CDI following PPI and histamine-2 receptor antagonist (H2RA) use. We evaluated the comparative hospital-acquired CDI occurrence risk associated with the concurrent use of PPIs versus H2RAs.
A systematic search of PubMed, MEDLINE/Ovid, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, and Google Scholar through August 19, 2016, identified 12 studies that reported the hospital-acquired CDI occurrence following H2RA and PPI use for the prevention and treatment of stress gastric ulcers. Random-effects pooled odds ratios and 95% confidence intervals were estimated. Heterogeneity was measured using ², and a meta-regression analysis was conducted. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system was used to assess the overall quality of the evidence.
A total of 74,132 patients from 12 observational studies were analyzed. Compared to H2RAs, PPIs increased the risk of CDI by 38.6% (pooled odds ratio, 1.386; 95% confidence interval, 1.152 to 1.668; p=0.001; ²=42.81%). Subgroup analyses of the purpose of study medication use, study site, and study design confirmed the consistency of a greater CDI risk with PPIs than with H2RAs. The overall quality of evidence was rated as low.
The use of PPIs for both the prevention and treatment of stress ulcers was associated with a 38.6% increased risk of hospital-acquired CDI occurrence compared to H2RA use.
背景/目的：质子泵抑制剂（PPIs）已广泛用于预防和治疗医院环境中的应激性胃溃疡，但人们担心 PPI 会增加感染（CDI）的风险。然而，对于 PPI 和组胺 2 受体拮抗剂（H2RA）使用后 CDI 的风险知之甚少。我们评估了同时使用 PPI 与 H2RA 与医院获得性 CDI 发生风险的相关性。
通过 8 月 19 日之前对 PubMed、MEDLINE/Ovid、护理和联合健康文献累积索引（CINAHL）、Web of Science 和 Google Scholar 的系统搜索，确定了 12 项研究报告了使用 H2RA 和 PPI 预防和治疗应激性胃溃疡时发生医院获得性 CDI 的情况。使用随机效应汇总比值比和 95%置信区间进行估计。使用 ²测量异质性，并进行了荟萃回归分析。使用推荐评估、制定和评估（GRADE）系统评估证据的总体质量。
对来自 12 项观察性研究的 74132 名患者进行了分析。与 H2RA 相比，PPIs 使 CDI 的风险增加了 38.6%（汇总比值比，1.386；95%置信区间，1.152 至 1.668；p=0.001；²=42.81%）。对研究药物使用目的、研究地点和研究设计的亚组分析证实了与 H2RA 相比，PPIs 具有更大的 CDI 风险。证据的总体质量评为低。
与使用 H2RA 相比，预防和治疗应激性溃疡时使用 PPI 与医院获得性 CDI 发生风险增加 38.6%相关。
