Depression, antidepressant medications, and risk of Clostridium difficile infection

BMC Medicine

David M Aronoff¹  John Y Kao¹  Kenneth M Langa²  Sanjay Saint²  Vincent B Young¹  M Todd Greene¹  Mary A M Rogers¹ 

[1] Department of Internal Medicine, University of Michigan, 016-440E NCRC, Ann Arbor, MI 48109-2800, USA;Ann Arbor Veterans Affairs Medical Center, Ann Arbor, MI, USA

关键词: Antidepressant medication;    Depression;    Colitis;    Clostridium difficile;   

Others  :  857044
DOI  :  10.1186/1741-7015-11-121

 received in 2012-12-03, accepted in 2013-03-20,  发布年份 2013

【 摘 要 】

Background

An ancillary finding in previous research has suggested that the use of antidepressant medications increases the risk of developing Clostridium difficile infection (CDI). Our objective was to evaluate whether depression or the use of anti-depressants altered the risk of developing CDI, using two distinct datasets and study designs.

Methods

In Study 1, we conducted a longitudinal investigation of a nationally representative sample of older Americans (n = 16,781), linking data from biennial interviews to physician and emergency department visits, stays in hospital and skilled nursing facilities, home health visits, and other outpatient visits. In Study 2, we completed a clinical investigation of hospitalized adults who were tested for C. difficile (n = 4047), with cases testing positive and controls testing negative. Antidepressant medication use prior to testing was ascertained.

Results

The population-based rate of CDI in older Americans was 282.9/100,000 person-years (95% confidence interval (CI)) 226.3 to 339.5) for individuals with depression and 197.1/100,000 person-years for those without depression (95% CI 168.0 to 226.1). The odds of CDI were 36% greater in persons with major depression (95% CI 1.06 to 1.74), 35% greater in individuals with depressive disorders (95% CI 1.05 to 1.73), 54% greater in those who were widowed (95% CI 1.21 to 1.95), and 25% lower in adults who did not live alone (95% CI 0.62 to 0.92). Self-reports of feeling sad or having emotional, nervous or psychiatric problems at baseline were also associated with the later development of CDI. Use of certain antidepressant medications during hospitalization was associated with altered risk of CDI.

Conclusions

Adults with depression and who take specific anti-depressants seem to be more likely to develop CDI. Older adults who are widowed or who live alone are also at greater risk of CDI.

【 授权许可】

   
2013 Rogers et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Miller BA, Chen LF, Sexton DJ, Anderson DJ: Comparison of the burdens of hospital-onset, healthcare facility-associated Clostridium difficile infection and of healthcare-associated infection due to methicillin-resistant Staphylococcus aureus in community hospitals. Infect Control Hosp Epidemiol 2011, 32:387-390.
• [2]Murphy SL, Xu JQ, Kochanek KD: Deaths: preliminary data for 2010. National Vital Statistics Reports. Natl Center Health Stat 2012, 60:1-69.
• [3]Bauer MP, Notermans DW, van Benthem BH, Brazier JS, Wilcox MH, Rupnik M, Monnet DL, van Dissel JT, Kuijper EJ, ECDIS Study Group: Clostridium difficile infection in Europe: a hospital-based survey. Lancet 2011, 377:63-73.
• [4]Leonard J, Marshall JK, Moayyedi P: Systematic review of the risk of enteric infection in patients taking acid suppression. Am J Gastroenterol 2007, 102:2047-2056.
• [5]Dalton BR, Lye-Maccannell T, Henderson EA, Maccannell DR, Louie TJ: Proton pump inhibitors increase significantly the risk of Clostridium difficile infection in a low-endemicity, non-outbreak hospital setting. Aliment Pharmacol Ther 2009, 29:626-634.
• [6]World Health Organization: The global burden of disease: 2004 update. WHO Press; 2008. http://www.who.int/healthinfo/global_burden_disease/2004_report_update/en/ webcite
• [7]O'Malley D, Julio-Pieper M, Gibney SM, Dinan TG, Cryan JF: Distinct alterations in colonic morphology and physiology in two rat models of enhanced stress-induced anxiety and depression-like behaviour. Stress 2010, 13:114-122.
• [8]Maes M, Kubera M, Leunis JC: The gut-brain barrier in major depression: intestinal mucosal dysfunction with an increased translocation of LPS from gram negative enterobacteria (leaky gut) plays a role in the inflammatory pathophysiology of depression. Neuro Endocrinol Lett 2008, 29:117-124.
• [9]Dinan TG, Cryan JF: Regulation of the stress response by the gut microbiota: Implications for psychoneuroendocrinology. Psychoneuroendocrinology 2012, 37:1369-1378.
• [10]Varghese AK, Verdú EF, Bercik P, Khan WI, Blennerhassett PA, Szechtman H, Collins SM: Antidepressants attenuate increased susceptibility to colitis in a murine model of depression. Gastroenterology 2006, 130:1743-1753.
• [11]Kurina LM, Goldacre MJ, Yeates D, Gill LE: Depression and anxiety in people with inflammatory bowel disease. J Epidemiol Community Health 2001, 55:716-720.
• [12]Walker JR, Ediger JP, Graff LA, Greenfeld JM, Clara I, Lix L, Rawsthorne P, Miller N, Rogala L, McPhail CM, Bernstein CN: The Manitoba IBD cohort study: a population-based study of the prevalence of lifetime and 12-month anxiety and mood disorders. Am J Gastroenterol 2008, 103:1989-1997.
• [13]Juster FT, Suzman R: An overview of the Health and Retirement Study. J Hum Resour 1995, 30:S7-S56.
• [14]Scheurer DB, Hicks LS, Cook EF, Schnipper JL: Accuracy of ICD-9 coding for Clostridium difficile infections: a retrospective cohort. Epidemiol Infect 2007, 135:1010-1013.
• [15]Ghia JE, Blennerhassett P, Deng Y, Verdu EF, Khan WI, Collins SM: Reactivation of inflammatory bowel disease in a mouse model of depression. Gastroenterology 2009, 136:2280-2288. e1–4
• [16]Jeffery IB, O'Toole PW, Öhman L, Claesson MJ, Deane J, Quigley EM, Simrén M: An irritable bowel syndrome subtype defined by species-specific alterations in faecal microbiota. Gut 2012, 61:997-1006.
• [17]Kowalski SD, Bondmass MD: Physiological and psychological symptoms of grief in widows. Res Nurs Health 2008, 31:23-30.
• [18]Glaser R, Robles TF, Sheridan J, Malarkey WB, Kiecolt-Glaser JK: Mild depressive symptoms are associated with amplified and prolonged inflammatory responses after influenza virus vaccination in older adults. Arch Gen Psychiatry 2003, 60:1009-1014.
• [19]Khanfer R, Lord JM, Phillips AC: Neutrophil function and cortisol: DHEAS ratio in bereaved older adults. Brain Behav Immun 2011, 25:1182-1186.
• [20]Gerra G, Monti D, Panerai AE, Sacerdote P, Anderlini R, Avanzini P, Zaimovic A, Brambilla F, Franceschi C: Long-term immune-endocrine effects of bereavement: relationships with anxiety levels and mood. Psychiatry Res 2003, 121:145-158.
• [21]Koloski NA, Jones M, Kalantar J, Weltman M, Zaguirre J, Talley NJ: The brain-gut pathway in functional gastrointestinal disorders is bidirectional: a 12-year prospective population-based study. Gut 2012, 61:1284-1290.
• [22]Leue C, van Os J, Neeleman J, de Graaf R, Vollebergh W, Stockbrügger RW: Bidirectional associations between depression/anxiety and bowel disease in a population based cohort. J Epidemiol Community Health 2005, 59:434-435.
• [23]Bravo JA, Forsythe P, Chew MV, Escaravage E, Savignac HM, Dinan TG, Bienenstock J, Cryan JF: Ingestion of Lactobacillus strain regulates emotional behavior and central GABA receptor expression in a mouse via the vagus nerve. Proc Natl Acad Sci USA 2011, 108:16050-16055.
• [24]Liu L, Li Q, Sapolsky R, Liao M, Mehta K, Bhargava A, Pasricha PJ: Transient gastric irritation in the neonatal rats leads to changes in hypothalamic CRF expression, depression- and anxiety-like behavior as adults. PLoS One 2011, 6:e19498.
• [25]Claesson MJ, Jeffery IB, Conde S, Power SE, O'Connor EM, Cusack S, Harris HM, Coakley M, Lakshminarayanan B, O'Sullivan O, Fitzgerald GF, Deane J, O'Connor M, Harnedy N, O'Connor K, O'Mahony D, van Sinderen D, Wallace M, Brennan L, Stanton C, Marchesi JR, Fitzgerald AP, Shanahan F, Hill C, Ross RP, O'Toole PW: Gut microbiota composition correlates with diet and health in the elderly. Nature 2012, 488:178-184.
• [26]Graff LA, Walker JR, Bernstein CN: Depression and anxiety in inflammatory bowel disease: a review of comorbidity and management. Inflamm Bowel Dis 2009, 15:1105-1118.
• [27]Shen B, Fazio VW, Remzi FH, Brzezinski A, Bennett AE, Lopez R, Hammel JP, Achkar JP, Bevins CL, Lavery IC, Strong SA, Delaney CP, Liu W, Bambrick ML, Sherman KK, Lashner BA: Risk factors for diseases of ileal pouch-anal anastomosis after restorative proctocolectomy for ulcerative colitis. Clin Gastroenterol Hepatol 2006, 4:81-89.
• [28]Ghia JE, Li N, Wang H, Collins M, Deng Y, El-Sharkawy RT, Côté F, Mallet J, Khan WI: Serotonin has a key role in pathogenesis of experimental colitis. Gastroenterology 2009, 137:1649-1660.
• [29]Edwards JG: Selective serotonin reuptake inhibitors. BMJ 1992, 304:1644-1646.
• [30]Murphy GM Jr, Kremer C, Rodrigues HE, Schatzberg AF: Pharmacogenetics of antidepressant medication intolerance. Am J Psychiatry 2003, 160:1830-1835.
• [31]Lessa FC, Gould CV, McDonald LC: Current status of Clostridium difficile infection epidemiology. Clin Infect Dis 2012, 55:S65-S70.