立即登录 | 免费注册
全部学科 | 内科学 | 心血管病学 | 内分泌学与糖尿病 | 神经病学 | 消化病学 | 呼吸病学 | 肿瘤学 | 妇产科学 | 骨科学
疾病中心： 高血压 | 冠心病 | 心力衰竭 | 心律失常 | 脂肪性肝病 | 糖尿病 | 卒中 | 慢性阻塞性肺病 | 子宫内膜异位症 | 乳腺癌 | 肺癌 | 结直肠癌 | 器官移植
Loading
当前位置：期刊中心 > 全球精选文摘 > 文摘导读

医源性胃酸抑制与院内难辨梭菌感染风险

Iatrogenic Gastric Acid Suppression and the Risk of Nosocomial Clostridium difficile Infection
Howell MD, Novack V, Grgurich P   |    2010/8/9 15:04:29   | 
Arch Intern Med  |   2010   |          View at Publisher
专家评级： ★★  |    循证评级： B   |  【全球专家评论】 |   打印| 推荐给好友
上一篇： 急性胆囊炎老年患者胆囊切除术失败与患病率、死亡率和医疗费用增加相关
下一篇： 识别接受胃肠手术的老年患者特定的质量改进机遇
Background:
The incidence and severity of Clostridium difficile infections are increasing. Acidsuppressive therapy has been suggested as a risk factor for C difficile, but this remains controversial.

Methods:
We conducted a pharmacoepidemiologic cohort study, performing a secondary analysis of data collected prospectively on 101 796 discharges from a tertiary care medical center during a 5-year period. The primary exposure of interest was acid suppression therapy, classified by the most intense acid suppression therapy received (no acid suppression, histamine2-receptor antagonist [H2RA] therapy, daily proton pump inhibitor [PPI], and PPI more frequently than daily).

Results:
As the level of acid suppression increased, the risk of nosocomial C difficile infection increased, from 0.3% (95% confidence interval [CI], 0.21%-0.31%) in patients not receiving acid suppressive therapy to 0.6% (95% CI, 0.49%-0.79%) in those receiving H2RA therapy, to 0.9% (95% CI, 0.80%-0.98%) in those receiving daily PPI treatment, and to 1.4% (1.15%-1.71%) in those receiving more frequent PPI therapy. After adjustment for comorbid conditions, age, antibiotics, and propensity score–based likelihood of receipt of acid-suppression therapy, the association persisted, increasing from an odds ratio of 1 (no acid suppression [reference]) to 1.53 (95% CI, 1.12-2.10) (H2RA), to 1.74 (95% CI, 1.39-2.18) (daily PPI), and to 2.36 (95% CI, 1.79-3.11) (more frequent PPI). Similar estimates were found with a matched cohort analysis and with nested case-control techniques.

Conclusions:
Increasing levels of pharmacologic acid suppression are associated with increased risks of nosocomial C difficile infection. This evidence of a dose-response effect provides further support for the potentially causal nature of iatrogenic acid suppression in the development of nosocomial C difficile infection.
关键词:

请登录后发表评论，点击此处登录。

慢性心衰诊治：规范中求突破
黄峻
2012-2-1
南京医科大学第一附属医院
房颤治疗：手段渐趋丰富 新型治疗药物不断涌现 非药物治疗备受关注
马长生
2012-2-1
首都医科大学附属北京安贞医院
注重老年人群特征 优化管理

刘梅林
2012-2-1
北京大学第一医院老年内科

 
相关文章