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Upper Gastrointestinal Perforations: A Possible Danger of Antibiotic Overuse.

Authors
  • Daniel, Vijaya T1
  • Francalancia, Stephanie2
  • Amir, Nili S3
  • Ayturk, M Didem4
  • Sanders, Stacy B1
  • Wisler, Jonathan R5
  • Collins, Courtney E5
  • Ward, Doyle V6
  • Kiefe, Catarina I4
  • McCormick, Beth A6
  • Santry, Heena P7
  • 1 Department of Surgery, University of Massachusetts Medical School, Worcester, Massachusetts, USA.
  • 2 University of Michigan, Ann Arbor, Michigan, USA.
  • 3 University of Massachusetts Medical School, Worcester, Massachusetts, USA.
  • 4 Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA.
  • 5 Department of Surgery, Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
  • 6 Center for Microbiome Research, University of Massachusetts Medical School, Worcester, Massachusetts, USA.
  • 7 Department of Surgery, Ohio State University Wexner Medical Center, Columbus, Ohio, USA. [email protected]
Type
Published Article
Journal
Journal of Gastrointestinal Surgery
Publisher
Springer-Verlag
Publication Date
Dec 01, 2020
Volume
24
Issue
12
Pages
2730–2736
Identifiers
DOI: 10.1007/s11605-019-04473-w
PMID: 31845145
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

The role of changes in gut microflora on upper gastrointestinal (UGI) perforations is not known. We conducted a retrospective case-control study to examine the relationship between antibiotic exposure-a proxy for microbiome modulation-and UGI perforations in a national sample. We queried a 5% random sample of Medicare (2009-2013) to identify patients ≥ 65 years old hospitalized with UGI (stomach or small intestine) perforations using International Classification of Diseases diagnosis codes. Cases with UGI perforations were matched with 4 controls, each based on age and sex. Exposure to outpatient antibiotics (0-30, 31-60, 61-90 days) prior to case patients' index hospitalization admission data was determined with Part D claims. Univariate and multivariable regression analyses were performed to evaluate the effect of antibiotic exposure on UGI perforation. Overall, 504 cases and 2016 matched controls were identified. Compared to controls, more cases had antibiotic exposure 0-30 days (19% vs. 3%, p < 0.001) and 31-60 days (5% vs. 2%, p < 0.001) prior to admission. In adjusted analyses, antibiotic exposure 0-30 days prior to admission was associated with 6.8 increased odds of an UGI perforation (95% CI 4.8, 9.8); 31-60 days was associated with 1.9 increased odds (95% CI 1.1, 3.3); and 61-90 days was associated with 3.7 increased odds (95% CI 2.0, 6.9). Recent outpatient antibiotic use, in particular in the preceding 30 days, is associated with UGI perforation among Medicare beneficiaries. Exposure to antibiotics, one of the most modifiable determinants of the microbiome, should be minimized in the outpatient setting.

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