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目的质子泵抑制剂(Proton pump inhibitors,PPI)已经被证实与艰难梭状芽孢杆菌相关腹泻(Clostridium difficile-associated diarrhea,CDAD)相关,但是关于重症监护病房(Intensive Care Unit,ICU)患者的研究仍然较少或没有系统性的分析,我们探讨ICU患者中应用PPI增加CDAD的风险。方法采用回顾性的病例对照研究,感染艰难梭状芽胞杆菌(Clostridium difficile,CD)的患者使用ICD-9编码作为第二诊断进行鉴定。患者在感染CD前必须在ICU入住超过48h,然后使用ICD-9首次诊断、年龄(±5岁)和SOFA评分(±1)选取未感染CD的患者作为对照组与之配对。回顾成功配对的患者关于PPI使用情况及其他潜在的CD感染混杂变量。PPI使用分为<2d和≥2d。运用多变量模型确定感染CD的风险因素。结果共有300例患者入组,其中有81%的患者接受了PPI治疗。病例组有85%的患者使用PPI≥2d,而对照组只有72%(P=0.011)。在多变量(使用PPI≥2d,使用H2RA,使用抗生素,使用免疫抑制剂分析中,使用PPI≥2d(OR(95%CI)=1.887(1.023~3.478),(P=0.042)和使用抗生素(OR(95%CI)=2.620(1.093~6.278),(P=0.031)分别是引起CD感染的两个独立因素。结论 PPI是ICU患者感染CD的独立风险因素,尤其是在使用2d或更久的PPI的情况下。
Purpose Proton pump inhibitors (PPIs) have been shown to be associated with Clostridium difficile-associated diarrhea (CDAD), but studies in intensive care unit (ICU) patients remain With little or no systematic analysis, we explore the use of PPI in patients with ICU to increase the risk of CDAD. Methods Using a retrospective case-control study, patients infected with Clostridium difficile (CD) were identified using the ICD-9 code as the second diagnosis. Patients had to stay in the ICU for more than 48 hours prior to infection and then paired with non-infected CD patients as the control using a first diagnosis of ICD-9, age (± 5 years) and SOFA score (± 1). Review the successful paired patients for PPI use and other potential CD-confounding variables. PPI use is divided into <2d and ≥ 2d. Multivariate modeling was used to determine the risk factors for CD infection. Results A total of 300 patients were enrolled, of whom 81% received PPI. 85% of patients in the case group had PPI ≥2 days compared with 72% in the control group (P = 0.011). In the multivariate (PPI ≥2d, H2RA, antibiotic use, PPI ≥2d (OR (95% CI) = 1.887 (1.023-3.478), (P = 0.042) OR (95% CI) = 2.620 (1.093 ~ 6.278), respectively (P = 0.031) were two independent factors of CD infection.Conclusion PPI is an independent risk factor for CD infection in ICU patients, especially in the use of 2d or longer PPI case.