治疗幽门螺杆菌与未来艰难梭菌感染无关。
Treatment of Helicobacter pylori Is Not Associated With Future Clostridium difficile Infection.
机构信息
Division of Gastroenterology and Hepatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Division of Gastroenterology, Veterans Health Administration, Philadelphia, Pennsylvania, USA.
出版信息
Am J Gastroenterol. 2020 May;115(5):716-722. doi: 10.14309/ajg.0000000000000626.
INTRODUCTION
Helicobacter pylori (HP) infection is associated with many gastrointestinal disorders, including gastric cancer, and consensus guidelines recommend eradication after detection. There is a theoretical, yet uninvestigated, concern that HP treatment could increase the risk of Clostridium difficile infection (CDI). Using the data from a large cohort of patients with HP, we investigated whether HP eradication is associated with CDI.
METHODS
A retrospective cohort study within the Veterans Health Administration on 38,535 patients (median age 61.8 years; 91.8% men) with detected HP between January 1, 1994, and December 31, 2018 was conducted. Primary outcome was a positive laboratory test for CDI within 3 months of HP detection. Multivariable logistic regression evaluated the following: patient demographics, previous CDI, recent hospitalization, and whether the patient received HP eradication therapy (by antibiotic and regimen, and including proton pump therapy). Secondary analysis of those treated evaluated whether eradication of HP was associated with CDI.
RESULTS
Among 38,535 patients, 28,818 (74.8%) were treated for HP and 284 (0.74%) developed CDI. In multivariable analysis, prominent factors included hospital discharge within 12 weeks (odds ratio [OR] 2.15; 95% confidence interval [CI]: 1.22-3.77) and 4 weeks (OR 3.46; 95% CI: 2.18-5.48), P < 0.001, and previous CDI (OR 12.5; 95% CI: 9.21-17.0, P < 0.001). Treatment of HP was not associated with future CDI. In secondary analysis of those treated, confirmation of eradication was not associated with future CDI (OR 1.49; 95% CI: 0.67-3.29).
DISCUSSION
In a large study of US patients with HP, we demonstrate that neither treatment nor eradication of HP is associated with CDI. Previous C. difficile infection and recent hospital discharge, established risk factors for CDI, are strongly associated. These findings suggest that treatment should be continued to be prescribed when HP is detected (http://links.lww.com/AJG/B507).
简介
幽门螺杆菌（HP）感染与许多胃肠道疾病有关，包括胃癌，共识指南建议在检测到后进行根除。有一种理论上的、尚未被研究的担忧是，HP 治疗可能会增加艰难梭菌感染（CDI）的风险。本研究利用大型 HP 患者队列的数据，调查了 HP 根除是否与 CDI 相关。
方法
对 1994 年 1 月 1 日至 2018 年 12 月 31 日期间，退伍军人健康管理局（Veterans Health Administration）内的 38535 例（中位年龄 61.8 岁；91.8%为男性）有 HP 检测结果的患者进行了回顾性队列研究。主要结局是在 HP 检测后 3 个月内进行 CDI 的阳性实验室检测。多变量逻辑回归评估了以下因素：患者人口统计学特征、既往 CDI、近期住院和是否接受 HP 根除治疗（通过抗生素和方案，包括质子泵治疗）。对接受治疗的患者进行了二次分析，以评估 HP 根除是否与 CDI 相关。
结果
在 38535 例患者中，28818 例（74.8%）接受了 HP 治疗，284 例（0.74%）发生 CDI。多变量分析中，显著的因素包括 12 周内出院（比值比[OR]2.15；95%置信区间[CI]：1.22-3.77）和 4 周内出院（OR 3.46；95% CI：2.18-5.48），P < 0.001，以及既往 CDI（OR 12.5；95% CI：9.21-17.0，P < 0.001）。HP 治疗与未来 CDI 无关。在接受治疗的患者的二次分析中，HP 根除的确认与未来 CDI 无关（OR 1.49；95% CI：0.67-3.29）。
讨论
在一项针对美国 HP 患者的大型研究中，我们证明了 HP 的治疗或根除均与 CDI 无关。先前的艰难梭菌感染和近期的住院，是 CDI 的既定危险因素，与 CDI 强烈相关。这些发现表明，当检测到 HP 时，应继续开处方治疗（http://links.lww.com/AJG/B507）。
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