Early-Life Infections, Antibiotics and Later Risk of Childhood and Early Adult-Onset Inflammatory Bowel Disease: Pooled Analysis of Two Scandinavian Birth Cohorts

IF 6.7 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Alimentary Pharmacology & Therapeutics Pub Date : 2024-10-25 DOI:10.1111/apt.18358

Karl Mårild, Tereza Lerchova, Malin Östensson, Henrik Imberg, Ketil Størdal, Johnny Ludvigsson

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Abstract

Background

Childhood antibiotic use has been associated with inflammatory bowel disease (IBD), although the potential contribution of infection frequency remains uncertain.

Aims

To explore the association between early-life infections, antibiotics and IBD development.

Methods

We used population-based data from ABIS (Sweden) and MoBa (Norway) cohorts following children from birth (1997–2009) until 2021. Prospectively collected questionnaires identified infection frequency (any, gastrointestinal and respiratory) and antibiotics (any, penicillin and non-penicillin) until age 3. IBD diagnosis required ≥ 2 records in national health registries. Cohort-specific hazard ratios (aHR), adjusted for parental education, smoking and IBD were estimated and pooled using a random-effects model. Antibiotic analyses were adjusted for infection frequency.

Results

There were 103,046 children (11,872 ABIS and 91,174 MoBa), contributing to 1,663,898 person-years of follow-up, during which 395 were diagnosed with IBD. The frequency of any infection at 0 to < 1 and 1 to < 3 years showed a pooled aHR of 1.01 (95% confidence interval [CI] = 0.96–1.07) and 1.00 (95% CI = 0.99–1.01) per additional infection for IBD. Adjusting for infections, any versus no antibiotics in the first year was associated with IBD (pooled aHR = 1.33 [95% CI = 1.01–1.76]). The aHR for additional antibiotic course was 1.17 (95% CI = 0.96–1.44), driven by penicillin (per additional course, aHR = 1.28 [95% CI = 1.02–1.60]). Although antibiotics at 1 to < 3 years did not show an association with IBD or Crohn's disease, non-penicillin antibiotics were associated with ulcerative colitis (per additional course, aHR = 1.95 [95% CI = 1.38–2.75]).

Conclusion

Early-life antibiotic use was, a significant risk factor for childhood and early adult-onset IBD, independent of infection frequency.

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生命早期感染、抗生素与儿童期和成年早期炎症性肠病的后期发病风险：两个斯堪的纳维亚出生队列的汇总分析

背景儿童时期抗生素的使用与炎症性肠病（IBD）有关，但感染频率的潜在影响仍不确定。方法我们使用了来自 ABIS（瑞典）和 MoBa（挪威）队列的基于人口的数据，这些数据跟踪了儿童从出生（1997-2009 年）到 2021 年的情况。前瞻性收集的问卷调查确定了3岁前的感染频率（任何感染、胃肠道感染和呼吸道感染）和抗生素使用情况（任何抗生素、青霉素和非青霉素）。IBD的诊断需要在国家健康登记簿上有≥2条记录。使用随机效应模型估算并汇总了同组特异性危险比（aHR），并对父母教育程度、吸烟和 IBD 进行了调整。结果共有 103,046 名儿童（11,872 名 ABIS 儿童和 91,174 名 MoBa 儿童）接受了 1,663,898 人年的随访，其中 395 名儿童被诊断出患有 IBD。0至1年和1至3年的任何感染频率显示，IBD每增加1例感染的合并死亡率分别为1.01（95% 置信区间 [CI] = 0.96-1.07）和1.00（95% CI = 0.99-1.01）。对感染进行调整后，第一年使用任何抗生素与未使用抗生素均与 IBD 相关（汇总 aHR = 1.33 [95% CI = 1.01-1.76]）。在青霉素的作用下，额外抗生素疗程的 aHR 为 1.17（95% CI = 0.96-1.44）（每个额外疗程，aHR = 1.28 [95% CI = 1.02-1.60]）。结论早期使用抗生素是儿童期和成年早期IBD的重要风险因素，与感染频率无关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Alimentary Pharmacology & Therapeutics 医学-胃肠肝病学

CiteScore

15.60

自引率

7.90%

发文量

527

审稿时长

3-6 weeks

期刊介绍： Alimentary Pharmacology & Therapeutics is a global pharmacology journal focused on the impact of drugs on the human gastrointestinal and hepato-biliary systems. It covers a diverse range of topics, often with immediate clinical relevance to its readership.