V. T. Daniel1, S. Sanders1, D. Ayturk1, B. A. McCormick2, H. P. Santry1 1University Of Massachusetts Medical School,Department Of Surgery,Worcester, MA, USA 2University Of Massachusetts Medical School,Center For Microbiome Research,Worcester, MA, USA
Introduction: Approximately 266 million courses of antibiotics are issued annually in the US with the rising elderly population consuming a large number of antibiotics nationally. Exposure to antibiotics is a modifiable determinant of microbiota, and nosocomial infections from antibiotic-induced microbiome dysbiosis have been well-studied. Alterations in gut microbiome, possibly through inducing a pro-inflammatory state, are also known to cause gastrointestinal (GI) perforations. However, the effect of antibiotics, a proxy of microbiome modulation, on the incidence of GI perforations is unknown.
Methods: For this case-control design, we queried a 5% random sample of Medicare beneficiaries (2009-2011) to identify patients who were ≥ 65 years with stomach, small intestine, or large intestine perforations. Exposure was previous outpatient antibiotic use (0-30 days, 31-60 days, or 61-90 days prior to admission). Cases had GI perforations, while controls did not have GI perforations and were matched by age and sex. Univariate and multivariable regression analyses were performed.
Results: We identified 5929 cases and 29,645 matched controls. Compared to matched controls, 0-30 day (prior to admission) antibiotic use was higher among cases (27% vs. 8%, p<0.0001), 31-60 day antibiotic use was higher among cases (8% vs. 6%, p<0.0001), and 61-90 day antibiotic use was higher in cases (5.4% vs. 4.7%, p<0.0001). No antibiotic 90 days prior to admission was lower among cases compared to controls (60% vs. 81%, p<0.0001). Of those who used antibiotics 0-90 days prior to admission, the odds of developing a GI perforation was highest in the antibiotic use 0-30 days prior to admission. Specifically, among all antibiotic users, the use of fluoroquinolones was a significant predictor of GI perforations compared to other antibiotic classes (OR 2.1, 95% CI 1.87, 2.37).
Conclusion: Recent antibiotics increase the odds of developing a GI perforation, with the most recent antibiotic use (0-30 days) having the greatest odds. Minimizing exposure to antibiotics may lower the incidence of GI perforations. Exposure to antibiotics, one of the most modifiable determinants of microbiota, should be minimized in the outpatient setting.