Antibiotics linked to upper GI perforation in elderly patients

Takeaway

• Recent outpatient antibiotic use is associated with increased odds of upper gastrointestinal (UGI) perforation in elderly patients.

Why this matters

• Minimising outpatient exposure to antibiotics may reduce incidence of UGI perforations, ultimately reducing morbidity and mortality.

Study design

• Researchers analysed the health records of patients aged ≥65 years who were hospitalised with UGI perforations in the stomach or small intestine (n=504; 67.5 women; 88.1% white), comparing antibiotic exposures and outcomes with those of age- and sex-matched control patients without UGI perforations (n=2016).
• Funding: NIH; Agency for Healthcare Research Quality.

Key results

• Patients with UGI perforations were more likely than control patients to have antibiotic exposure before admission:
  • 0-30 days: 19% vs 3% (P<.001).
  • 31-60 days: 5% vs 2% (P<.001).
• Antibiotic exposure within 30 days before admission was associated with the greatest risk for UGI perforation (OR, 6.8; 95% CI, 4.8-9.8), after adjustments for race, Elixhauser comorbidity scores, and use of proton pump inhibitors (PPIs), NSAIDs, or steroids.

Limitations

• The study did not account for the use of over-the-counter PPIs and NSAIDs.
• Antibiotic exposures were based on dates of dispensation, numbers of doses, and instructions for use.