Carlson Travis J, Gonzales-Luna Anne J, Wilcox Melissa F, Theriault Sarah G, Alnezary Faris S, Patel Pankaj, Ahn Bumhee K, Zasowski Evan J, Garey Kevin W
Department of Clinical Sciences, High Point University Fred Wilson School of Pharmacy, High Point, North Carolina, USA.
Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, Houston, Texas,USA.
Open Forum Infect Dis. 2021 Aug 11;8(10):ofab419. doi: 10.1093/ofid/ofab419. eCollection 2021 Oct.
The pathogenesis of infection (CDI) involves a significant host immune response. Generally, corticosteroids act by suppressing the host inflammatory response, and their anti-inflammatory effects are used to treat gastrointestinal disorders. Although previous investigations have demonstrated mixed results regarding the effect of corticosteroids on CDI, we hypothesized that the anti-inflammatory effect of corticosteroids would decrease the risk of CDI in hospitalized patients.
This was a case-control study of hospitalized adults. The case population included patients diagnosed with primary CDI who received at least 1 dose of a high-risk antibiotic (cefepime, meropenem, or piperacillin-tazobactam) in the 90 days before CDI diagnosis. The control population included patients who received at least 1 dose of the same high-risk antibiotic but did not develop CDI in the 90 days following their first dose of antibiotic. The primary study outcome was the development of CDI based on receipt of corticosteroids.
The final study cohort consisted of 104 cases and 153 controls. Those who received corticosteroids had a lower odds of CDI after adjusting for age, proton pump inhibitor use, and antibiotic days of therapy (odds ratio, 0.54; 95% CI, 0.30-0.97; = .04). We did not observe an association between corticosteroid dose or duration and CDI.
We demonstrated a 46% relative reduction in the odds of developing CDI in patients who received corticosteroids in the past 90 days. We believe that our results provide the best clinical evidence to further support mechanistic studies underlying this phenomenon.
艰难梭菌感染（CDI）的发病机制涉及显著的宿主免疫反应。一般来说，皮质类固醇通过抑制宿主炎症反应发挥作用，其抗炎作用被用于治疗胃肠道疾病。尽管先前的研究表明皮质类固醇对CDI的影响结果不一，但我们推测皮质类固醇的抗炎作用会降低住院患者发生CDI的风险。
这是一项针对住院成人的病例对照研究。病例组包括在CDI诊断前90天内接受至少1剂高风险抗生素（头孢吡肟、美罗培南或哌拉西林-他唑巴坦）治疗且被诊断为原发性CDI的患者。对照组包括接受至少1剂相同高风险抗生素治疗，但在首次使用抗生素后的90天内未发生CDI的患者。主要研究结局是基于是否接受皮质类固醇治疗而发生的CDI。
最终的研究队列包括104例病例和153例对照。在调整年龄、质子泵抑制剂使用情况和抗生素治疗天数后，接受皮质类固醇治疗的患者发生CDI的几率较低（比值比，0.54；95%置信区间，0.30 - 0.97；P = 0.04）。我们未观察到皮质类固醇剂量或疗程与CDI之间存在关联。
我们证明，在过去90天内接受皮质类固醇治疗的患者发生CDI的几率相对降低了46%。我们认为，我们的结果为进一步支持这一现象背后的机制研究提供了最佳临床证据。
