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首页> 外文期刊>Gut and Liver >Comparison of the Hospital-Acquired Clostridium difficile Infection Risk of Using Proton Pump Inhibitors versus Histamine-2 Receptor Antagonists for Prophylaxis and Treatment of Stress Ulcers: A Systematic Review and Meta-Analysis
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Comparison of the Hospital-Acquired Clostridium difficile Infection Risk of Using Proton Pump Inhibitors versus Histamine-2 Receptor Antagonists for Prophylaxis and Treatment of Stress Ulcers: A Systematic Review and Meta-Analysis

机译：医院获得的使用质子泵抑制剂和组胺2受体拮抗剂预防和治疗应激性溃疡的艰难梭菌感染风险的比较：系统评价和荟萃分析

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Background/Aims Although proton pump inhibitors (PPIs) have been widely used for the prevention and treatment of stress gastric ulcers in hospital settings, there are concerns that PPIs increase the risk of Clostridium difficile infection (CDI). However, little is known about the risk of CDI following PPI and histamine-2 receptor antagonist (H2RA) use. We evaluated the comparative hospital-acquired CDI occurrence risk associated with the concurrent use of PPIs versus H2RAs. Methods A systematic search of PubMed, MEDLINE/Ovid, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, and Google Scholar through August 19, 2016, identified 12 studies that reported the hospital-acquired CDI occurrence following H2RA and PPI use for the prevention and treatment of stress gastric ulcers. Random-effects pooled odds ratios and 95% confidence intervals were estimated. Heterogeneity was measured using I ~(2), and a meta-regression analysis was conducted. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system was used to assess the overall quality of the evidence. Results A total of 74,132 patients from 12 observational studies were analyzed. Compared to H2RAs, PPIs increased the risk of CDI by 38.6% (pooled odds ratio, 1.386; 95% confidence interval, 1.152 to 1.668; p=0.001; I ~(2)=42.81%). Subgroup analyses of the purpose of study medication use, study site, and study design confirmed the consistency of a greater CDI risk with PPIs than with H2RAs. The overall quality of evidence was rated as low. Conclusions The use of PPIs for both the prevention and treatment of stress ulcers was associated with a 38.6% increased risk of hospital-acquired CDI occurrence compared to H2RA use.
机译：背景/目的尽管质子泵抑制剂（PPI）已在医院环境中广泛用于预防和治疗应激性胃溃疡，但人们担心PPI增加了艰难梭菌感染（CDI）的风险。但是，对于使用PPI和组胺2受体拮抗剂（H2RA）后发生CDI的风险知之甚少。我们评估了与同时使用PPI和H2RA相关的医院获得的CDI发生风险的比较。方法截至2016年8月19日，系统搜索PubMed，MEDLINE / Ovid，护理和相关健康文献累积索引（CINAHL），Web of Science和Google Scholar，确定了12项研究报告了H2RA和H2RA发生后医院获得性CDI的发生。 PPI用于预防和治疗应激性胃溃疡。估计了随机效应合并比值比和95％置信区间。使用I〜（2）测量异质性，并进行了Meta回归分析。建议评估，发展和评估分级（GRADE）系统用于评估证据的整体质量。结果对12项观察性研究的74132例患者进行了分析。与H2RA相比，PPI使CDI风险增加38.6％（合并赔率比1.386; 95％置信区间1.152至1.668; p = 0.001; I〜（2）= 42.81％）。对研究用药目的，研究地点和研究设计进行的亚组分析证实，与H2RA相比，PPI更大的CDI风险具有一致性。证据的总体质量被评为低。结论与H2RA相比，使用PPI预防和治疗应激性溃疡可使医院获得CDI发生的风险增加38.6％。

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