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Upper Gastrointestinal Perforations: A Possible Danger of Antibiotic Overuse
Vijaya T Daniel1, Stephanie Francalancia2, Nili S Amir3
1Department of Surgery, University of Massachusetts Medical School, Worcester, Massachusetts, USA.
Background:
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.
Methods:
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.
Results:
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).
Conclusions:
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.
Insights
Recent antibiotic use, especially within 30 days, significantly increases the risk of upper gastrointestinal (UGI) perforations in older adults. Minimizing outpatient antibiotic exposure may help prevent these serious UGI conditions.
Area of Science:
- Gastroenterology
- Microbiology
- Epidemiology
Background:
- The impact of gut microflora alterations on upper gastrointestinal (UGI) perforations remains unclear.
- This study investigates the association between antibiotic exposure, a proxy for microbiome modulation, and UGI perforations.
Purpose of the Study:
- To examine the relationship between outpatient antibiotic exposure and the occurrence of UGI perforations.
- To assess the risk of UGI perforations associated with varying durations of prior antibiotic use.
Main Methods:
- A retrospective case-control study utilizing a 5% sample of Medicare data (2009-2013).
- Identified patients aged 65+ hospitalized with UGI perforations and matched them with controls.
- Determined outpatient antibiotic exposure using Medicare Part D claims for periods of 0-30, 31-60, and 61-90 days prior to admission.
Main Results:
- Antibiotic exposure was more common in UGI perforation cases (19% at 0-30 days) compared to controls (3%).
- Adjusted analyses revealed increased odds of UGI perforation associated with antibiotic exposure: 6.8-fold at 0-30 days, 1.9-fold at 31-60 days, and 3.7-fold at 61-90 days.
Conclusions:
- Recent outpatient antibiotic use, particularly within 30 days, is linked to a higher risk of UGI perforations in Medicare beneficiaries.
- Reducing unnecessary outpatient antibiotic exposure is recommended to potentially prevent UGI perforations.
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