质子泵抑制剂使用与ICU患者艰难梭状芽孢杆菌感染腹泻的相关性研究

PPI INCREASED THE RISK OF ICU INFECTION IN PATIENTS WITH CD

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。

Objective To explore whether PPI can increase the risk of CDAD in patients with ICU.Methods A retrospective case control study was performed,and all the patients infected with Clostridium Bacillus Clostridium difficile（CD）were identified as the second diagnosis using ICD-9 codes.Patients with CD must be admitted to more than ICU before infection with 48 h,and then use ICD-9 for the first time,age（±5 years）and SOFA score（±1）to select patients without CD as a control group.A review of successful matched patients with PPI using the CD and other potential confounding variables.The use of PPI was divided into term 〈2 days and term ≥2days.Risk factors of infection with CD were analyzed by using multivariate model.Results A total of 300 patients were enrolled,81% of which received PPI.85% of patients in the case group had a long period of time,while the control group was only 72%（P=0.011）.PPI（1.023-3.478（P=1.887）P=0.042（CI）,OR（95% CI）PPI（1.093-6.278）,P=0.031,and（95%Cl=2.620）H2RA（OR）were used as the two independent factors in CD infection.Conclusion PPI is an independent risk factor for CD infection in patients with ICU,especially in the case of 2 days or longer.