Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA.
Harvard T.H. Chan School of Public Health, Boston, MA.
Clin Infect Dis. 2017 Oct 15;65(8):1349-1355. doi: 10.1093/cid/cix541.
Although emerging data demonstrate that obesity is a risk factor for infectious diseases, no study has investigated the relationship of bariatric surgery with the risk of infectious diseases among obese adults.
We conducted a self-controlled case series analysis using data from the State Emergency Department Database and State Inpatient Database of 3 US states (California, Florida, and Nebraska) from 2005 through 2011. We included obese adults who underwent bariatric surgery as an instrument of weight reduction. Primary outcomes were emergency department (ED) visit or hospitalization for skin and soft-tissue infection (SSTI), respiratory infection, intra-abdominal infection, or urinary tract infection (UTI).
Among 56277 obese adults who underwent bariatric surgery, compared to presurgery months 13-24 as the reference period, the risk of ED visit or hospitalization in the 0- to 12-month postsurgery period decreased significantly for SSTI (aOR, 0.85 [95% confidence interval {CI}, .76-.95]) and respiratory infection (aOR, 0.82 [95% CI, .75-.90]) and remained significantly low in the 13- to 24-month postsurgery period (aORs, 0.77 [95% CI, .68-.86] and 0.75 [95% CI, .68-.82], respectively). By contrast, the risk increased significantly in the 0- to 12-month postsurgery period for intra-abdominal infection (aOR, 2.09 [95% CI, 1.78-2.46]) and UTI (aOR, 1.93 [95% CI, 1.74-2.15]) and remained high in the 13- to 24-month postsurgery period (aORs, 1.29 [95% CI, 1.09-1.54] and 1.31 [95% CI, 1.17-1.47], respectively).
We found a divergent risk pattern in the risk of 4 common infectious diseases after bariatric surgery. The risk of SSTI and respiratory infection decreased after bariatric surgery whereas that of intra-abdominal infection and UTI increased.
尽管新出现的数据表明肥胖是传染病的一个危险因素，但尚无研究调查减重手术与肥胖成年人传染病风险之间的关系。
我们使用美国 3 个州（加利福尼亚州、佛罗里达州和内布拉斯加州）的州急救部门数据库和州住院患者数据库中的数据，开展了一项自身对照病例系列分析。我们纳入了作为减重手段而接受减重手术的肥胖成年人作为研究对象。主要结局是皮肤和软组织感染（SSTI）、呼吸道感染、腹腔内感染或尿路感染（UTI）的急诊就诊或住院。
在 56277 名接受减重手术的肥胖成年人中，与术前第 13-24 个月作为参考期相比，术后 0-12 个月期间 SSTI（调整后比值比 [aOR]，0.85 [95%置信区间 {CI}，0.76-0.95]）和呼吸道感染（aOR，0.82 [95% CI，0.75-0.90]）的急诊就诊或住院风险显著降低，且在术后 13-24 个月时风险仍保持较低水平（aORs，0.77 [95% CI，0.68-0.86] 和 0.75 [95% CI，0.68-0.82]）。相比之下，术后 0-12 个月时腹腔内感染（aOR，2.09 [95% CI，1.78-2.46]）和 UTI（aOR，1.93 [95% CI，1.74-2.15]）的风险显著升高，且在术后 13-24 个月时仍居高不下（aORs，1.29 [95% CI，1.09-1.54] 和 1.31 [95% CI，1.17-1.47]）。
我们发现减重手术后 4 种常见传染病的风险出现了不同的变化模式。SSTI 和呼吸道感染的风险在减重手术后降低，而腹腔内感染和 UTI 的风险则升高。
