Bejcek Alexis, Ancha Anupama, Lewis Megan, Beaver Ryan, Tecson Kristen, Bomar Jaccallene, Johnson Christopher
Division of Gastroenterology, Department of Medicine, Baylor Scott & White Medical Center, Temple, Texas, USA.
Division of Internal Medicine, Department of Medicine, Baylor Scott & White Medical Center, Temple, Texas, USA.
J Gastroenterol Hepatol. 2024 Nov;39(11):2417-2423. doi: 10.1111/jgh.16720. Epub 2024 Aug 15.
Patients with inflammatory bowel disease (IBD) have an increased risk of Clostridioides difficile infection (CDI) compared with those without IBD, which is worsened with antibiotic usage. While prior studies have shown a correlation between CDI development and certain classes of antibiotics, the IBD population has not been well represented. This study evaluates the rates of CDI with outpatient antibiotic use in patients with IBD.
We conducted a retrospective cohort study composed of patients with IBD and compared the incidence of CDI in patients who received an outpatient prescription for antibiotics (6694 patients) against those without prescriptions (6025 patients) from 2014 to 2020 at our institution. We compared CDI rates based on nine antibiotic classes: penicillins, cephalosporins, sulfonamides, tetracyclines, macrolides, quinolones, clindamycin, metronidazole, and nitrofurantoin.
The risk of CDI was low (0.7%) but significantly higher for those with antibiotic exposure (0.9% vs 0.5%, P = 0.005) and had a positive correlation with a smoking history. The increased risk of CDI in the IBD population was attributable to the clindamycin and metronidazole classes (odds ratio = 4.7, 95% confidence interval: 1.9-11.9, P = 0.001; odds ratio = 3.6, 95% confidence interval: 2.1-6.2, P < 0.0001, respectively).
The use of clindamycin or metronidazole prescribed in an outpatient setting was associated with a statistically significant increased risk of CDI in patients with IBD. Although the association between clindamycin and CDI is a well-established and common finding, the association between metronidazole and CDI is unique in this study.
与非炎症性肠病（IBD）患者相比，IBD患者发生艰难梭菌感染（CDI）的风险增加，而使用抗生素会使该风险进一步恶化。虽然先前的研究表明CDI的发生与某些种类的抗生素之间存在关联，但IBD人群在这些研究中并未得到充分体现。本研究评估IBD患者门诊使用抗生素时发生CDI的几率。
我们进行了一项回顾性队列研究，研究对象为IBD患者，并比较了2014年至2020年在我院接受门诊抗生素处方的患者（6694例）与未接受处方的患者（6025例）中CDI的发生率。我们根据九种抗生素类别比较了CDI发生率：青霉素类、头孢菌素类、磺胺类、四环素类、大环内酯类、喹诺酮类、克林霉素、甲硝唑和呋喃妥因。
CDI风险较低（0.7%），但抗生素暴露患者的风险显著更高（0.9%对0.5%，P = 0.005），且与吸烟史呈正相关。IBD人群中CDI风险增加归因于克林霉素和甲硝唑类别（比值比分别为4.7，95%置信区间：1.9 - 11.9，P = 0.001；比值比为3.6，95%置信区间：2.1 - 6.2，P < 0.
