North Shore Medical Center, Salem, MA, USA; Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA.
Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA; INRS-Institut Armand-Frappier, Institut National de la Recherche Scientifique, Laval, Québec, Canada.
Anaerobe. 2020 Feb;61:102095. doi: 10.1016/j.anaerobe.2019.102095. Epub 2019 Sep 4.
The prevalence of Clostridioides difficile Infection (CDI), the most notorious hospital acquired disease, and of excessive cannabis use (cannabis use disorder (CUD)) have both been steadily rising. Although cannabidiol, an active ingredient of cannabis, maintains gut integrity and suppresses entero-toxins from Clostridioides difficile, the relationship between CUD and CDI has not been studied.
We selected adult records (age ≥ 18 years) from the Nationwide Inpatient Sample 2014, and identified CUD and other clinical conditions using ICD-9-CM codes. We used propensity scores derived from a multivariate logistic model to match CUD to non-CUD in a 1:1 ratio (29,912:29,912). We estimated the relative risk for CDI using log-binomial regression models with generalized estimating equations [SAS 9.4].
Among the matched hospitalizations (n = 59,824), cannabis usage was associated with a reduced prevalence of CDI (prevalence: 455.5 [95% CI: 385.1-538.8] vs. 636.4 [95% CI: 549.9-736.5] per 100,000 hospitalizations), resulting in a 28% reduced risk of CDI (relative risk: 0.72 [95% CI: 0.58-0.88]; p = 0002). Non-dependent and dependent CUD respectively had 23% and 80% reduced likelihood of CDI when compared to non-cannabis users (0.77 [95% CI: 0.60-0.95] and 0.20 [95% CI: 0.06-0.54]; p < 0.05). Furthermore, dependent users had less risk of CDI compared to non-dependent users (0.26 [95% CI: 0.08-0.88]; p = 0.01).
CUD was associated with a decreased risk of CDI amongst hospitalized patients. Prospective and molecular mechanistic studies are required to elucidate how cannabis and its contents impacts CDI.
艰难梭菌感染（CDI）是最臭名昭著的医院获得性疾病，其发病率一直在稳步上升，同时，大麻的使用（大麻使用障碍（CUD））也在不断增加。虽然大麻的一种活性成分大麻二酚能维持肠道完整性并抑制艰难梭菌的肠毒素，但 CUD 和 CDI 之间的关系尚未得到研究。
我们从 2014 年全国住院患者样本中选择了成人记录（年龄≥18 岁），并使用 ICD-9-CM 代码识别 CUD 和其他临床情况。我们使用多元逻辑回归模型得出的倾向评分，以 1:1 的比例将 CUD 与非 CUD 匹配（29912 对 29912）。我们使用广义估计方程[SAS 9.4]对数二项式回归模型来估计 CDI 的相对风险。
在匹配的住院患者（n=59824）中，大麻使用与 CDI 的患病率降低相关（患病率：455.5 [95%CI：385.1-538.8]与 636.4 [95%CI：549.9-736.5]/100000 住院患者），导致 CDI 的风险降低 28%（相对风险：0.72 [95%CI：0.58-0.88]；p=0.0002）。与非大麻使用者相比，非依赖性和依赖性 CUD 发生 CDI 的可能性分别降低了 23%和 80%（0.77 [95%CI：0.60-0.95]和 0.20 [95%CI：0.06-0.54]；p<0.05）。此外，与非依赖性使用者相比，依赖性使用者发生 CDI 的风险较低（0.26 [95%CI：0.08-0.88]；p=0.01）。
在住院患者中，CUD 与 CDI 风险降低相关。需要前瞻性和分子机制研究来阐明大麻及其成分如何影响 CDI。
