克林霉素、庆大霉素与分娩住院期间艰难梭菌感染和急性肾损伤的风险
Clindamycin, Gentamicin, and Risk of Clostridium difficile Infection and Acute Kidney Injury During Delivery Hospitalizations.
机构信息
Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, New York.
出版信息
Obstet Gynecol. 2020 Jan;135(1):59-67. doi: 10.1097/AOG.0000000000003568.
OBJECTIVE
To describe risk of Clostridium difficile infection associated with clindamycin and acute kidney injury associated with gentamicin during delivery hospitalizations.
METHODS
Women admitted for delivery from January 2006 to March 2015 were analyzed using an inpatient administrative database. Primary outcomes were C difficile infection and acute kidney injury. C difficile infection was compared between women receiving clindamycin (with or without other antibiotics) and women receiving antibiotics other than clindamycin. Acute kidney injury was compared between women receiving gentamicin (with or without other antibiotics), women receiving antibiotics other than gentamicin, and women receiving no antibiotics. Unadjusted and adjusted log linear models analyzing the role of patient demographics, mode of delivery, and hospital-level characteristics were created evaluating risk of C difficile infection and acute kidney injury with risk ratios (RRs) and adjusted risk ratios with 99% CIs as measures of association. A sensitivity analysis for gentamicin and acute kidney injury was performed restricted to women with preeclampsia.
RESULTS
Of 5,657,523 women admitted for delivery hospitalization, 266,402 (4.7%) received clindamycin and 165,726 (2.9%) received gentamicin. C difficile infection was diagnosed in 0.04% of women receiving clindamycin. Compared with women receiving other antibiotics, clindamycin was associated with a nearly threefold increased risk of C difficile infection (RR 2.93, 99% CI 2.21-3.90). Acute kidney injury was diagnosed in 0.24% of women receiving gentamicin. Gentamicin was associated with a threefold increased risk of acute kidney injury (RR 3.01, 99% CI 2.62-3.45) compared with women receiving other antibiotics, whereas receipt of no antibiotics was associated with significantly lower risk (RR 0.18, 99% CI 0.15-0.20). In adjusted analyses, these associations retained significance. Significantly increased risk of acute kidney injury was noted for women with preeclampsia receiving gentamicin (RR 2.04, 99% CI 1.64-2.53).
CONCLUSION
Receipt of clindamycin was associated with significantly increased likelihood for C difficile infection and receipt of gentamicin with significantly increased likelihood of acute kidney injury, although the absolute risk of these complications was low.
目的
描述分娩住院期间克林霉素相关的艰难梭菌感染风险和庆大霉素相关的急性肾损伤风险。
方法
利用住院管理数据库，对 2006 年 1 月至 2015 年 3 月期间因分娩而住院的妇女进行分析。主要结局为艰难梭菌感染和急性肾损伤。比较接受克林霉素（联合或不联合其他抗生素）治疗的妇女与接受克林霉素以外的抗生素治疗的妇女之间的艰难梭菌感染率。比较接受庆大霉素（联合或不联合其他抗生素）、接受庆大霉素以外的抗生素和未接受抗生素治疗的妇女之间的急性肾损伤率。使用未调整和调整后的对数线性模型，根据患者人口统计学特征、分娩方式和医院水平特征，分析艰难梭菌感染和急性肾损伤的风险，以风险比（RR）和 99%置信区间（CI）调整后的 RR 作为关联性的衡量指标。对庆大霉素和急性肾损伤进行了敏感性分析，仅限于患有子痫前期的妇女。
结果
在 5657523 名分娩住院的妇女中，266402 名（4.7%）接受克林霉素治疗，165726 名（2.9%）接受庆大霉素治疗。接受克林霉素治疗的妇女中，艰难梭菌感染的诊断率为 0.04%。与接受其他抗生素治疗的妇女相比，克林霉素治疗与艰难梭菌感染风险增加近三倍相关（RR 2.93，99%CI 2.21-3.90）。接受庆大霉素治疗的妇女中，急性肾损伤的诊断率为 0.24%。与接受其他抗生素治疗的妇女相比，庆大霉素治疗与急性肾损伤风险增加三倍相关（RR 3.01，99%CI 2.62-3.45），而未接受抗生素治疗的妇女风险显著降低（RR 0.18，99%CI 0.15-0.20）。在调整后的分析中，这些关联仍然具有统计学意义。患有子痫前期的妇女接受庆大霉素治疗时，急性肾损伤的风险显著增加（RR 2.04，99%CI 1.64-2.53）。
结论
接受克林霉素治疗与艰难梭菌感染的可能性显著增加相关，而接受庆大霉素治疗与急性肾损伤的可能性显著增加相关，尽管这些并发症的绝对风险较低。
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