Antibiotics linked to upper GI perforation in elderly patients

  • Daniel VT & al.
  • J Gastrointest Surg
  • 16 Dec 2019

  • International Clinical Digest
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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.