Proton pump inhibitors as a risk factor for recurrence of Clostridium-difficile-associated diarrhea

查看全文 作　　者：Ji Won [1,2]Kim;Kook Lae [1,2]Lee;Ji Bong [1,2]Jeong;Byeong Gwan [1,2]Kim;Sue [3,2]Shin;Joo Sung [4,5]Kim;Hyun Chae [4,5]Jung;In Sung [4,5]Song 机构地区：[1]Division of Gastroenterology and Hepatology,Department of Internal Medicine,Seoul National University Boramae Hospital;[2]Seoul National University College of Medicine,Seoul 156-707,South Korea;[3]Department of Laboratory Medicine,Seoul National University Boramae Hospital;[4]Division of Gastroenterology and Hepatology,Department of Internal Medicine,Seoul National University Hospital;[5]Seoul National University College of Medicine,Seoul 110-744,South Korea 出　　处：《World Journal of Gastroenterology》索引2010年第16卷第28期,共5页 基　　金：Supported by A Seoul National University Boramae Hospital Grant(03-2007-1) 摘　　要：AIM:To investigate the risk factors for Clostridiumdifficile-associated diarrhea(CDAD)recurrence,and its relationship with proton pump inhibitors(PPIs). METHODS:Retrospective data of 125 consecutive hospitalized patients diagnosed with CDAD between January 2006 and December 2007 were collected by medical chart review.Collected data included patient characteristics at baseline,underlying medical disease, antibiotic history before receiving a diagnosis of CDAD, duration of hospital stay,severity of CDAD,concurrenttreatment with PPIs,laboratory parameters,response to CDAD therapy,and recurrence of disease within 90 d of successful treatment.Various clinical and laboratory parameters were compared in patients in whom CDAD did or did not recur. RESULTS:Of the 125 patients(mean age,67.6± 13.9 years)that developed CDAD,98(78.4%)did not experience recurrence(non-recurrent group)and 27 (21.6%)experienced one or more recurrences(recurrent group).Prior to the development of CDAD,96% of the 125 patients were prescribed antibiotics,and 56(44.8%)of the patients received PPIs.Age older than 65 years(P=0.021),feeding via nasogastric tube(NGT)(P=0.045),low serum albumin level(P =0.025),and concurrent use of PPIs(P=0.014) were found to be risk factors for CDAD recurrence by univariate analysis.However,sex,length of hospital stay,duration and type of antibiotics used,severity of disease,leukocyte count and C-reactive protein(CRP) were not associated with risk of CDAD recurrence.On multivariate analysis,the important risk factors were advanced age(>65 years,adjusted OR:1.32,95% CI:1.12-3.87,P=0.031),low serum albumin level(< 2.5 g/dL,adjusted OR:1.85,95%CI:1.35-4.91,P= 0.028),and concurrent use of PPIs(adjusted OR:3.48, 95%CI:1.64-7.69,P=0.016). CONCLUSION:Advanced age,serum albumin level< 2.5 g/dL,and concomitant use of PPIs were found to be significant risk factors for CDAD recurrence. 关 键 词：Clostridium difficile DIARRHEA RECURRENCE Risk factors Proton pump inhibitors