Introduction IBD patients have a relapsing-remitting disease course, and amongst environmental factors that aggravate the disease course, common drugs aside from NSAIDs are not studied in detail. While the microbiome is considered to play a significant role on the disease course the impact of antibiotics is poorly understood. This study investigated the potential impact of different classes of antibiotics on course of disease in IBD using the Danish National Patient Registry. Methods Danish IBD patients were studied using two nested case-control cohorts exploring associations between antibiotic types and IBD flare-ups, defined as IBD-related hospitalizations and/or high-dose systemic steroid exposure. Multivariate logistic regression and eXtreme Gradient Boosted decision tree (GBDT) machine learning methods evaluated antibiotic risks. Results Two cohorts with 15,636 and 5,178 patients were analysed for risk of hospitalisation and course of steroids, respectively. The risk of a flare-up was significantly increased with antecedent exposure to quinolones (ATC:J01M. OR:3.04-3.82), antimycotics (ATC:J02A. OR:1.50-2.30), agents against amoebiasis and protozoal infections (ATC:P01A. OR: 1.95-3.18), intestinal anti-infectives (ATC:A07A. OR:2.09-2.32) and beta-lactam antibiotics (ATC:J01C. OR:1.36). The GBDT models achieved an AUC between 0.71-0.85 for predicting flare-ups, with the same above-mentioned antibiotics being in the 10 most important variables. Conclusion We found distinctive antibiotics to be significantly associated with an increased risk of IBD flare-ups. Our findings are corroborated by our GBDT machine learning models. Healthcare providers should be aware about the deleterious potential of specific antibiotic groups in patients with IBD only using these agents in a restrictive manner or preferentially consider alternative antibiotic groups.

中文翻译：

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特定抗生素会增加炎症性肠病患者发病的风险——丹麦全国人群巢式病例对照研究的结果

引言IBD患者具有复发缓解型病程，而在加重病程的环境因素中，除NSAIDs外的常见药物尚未得到详细研究。虽然微生物组被认为在病程中发挥着重要作用，但人们对抗生素的影响却知之甚少。本研究利用丹麦国家患者登记处调查了不同类别的抗生素对 IBD 病程的潜在影响。方法 使用两个巢式病例对照队列对丹麦 IBD 患者进行研究，探讨抗生素类型与 IBD 发作（定义为 IBD 相关住院治疗和/或大剂量全身类固醇暴露）之间的关联。多元逻辑回归和极限梯度提升决策树 (GBDT) 机器学习方法评估了抗生素风险。结果 分别对 15,636 名和 5,178 名患者的两个队列进行了住院风险和类固醇疗程的分析。先前接触喹诺酮类药物（ATC：J01M。OR：3.04-3.82）、抗真菌药（ATC：J02A。OR：1.50-2.30）、抗阿米巴病和原虫感染药物（ATC：P01A），发作风险显着增加. OR: 1.95-3.18)、肠道抗感染药 (ATC:A07A. OR:2.09-2.32) 和 β-内酰胺抗生素 (ATC:J01C. OR:1.36)。GBDT 模型预测突发事件的 AUC 介于 0.71-0.85 之间，其中上述抗生素属于 10 个最重要的变量。结论 我们发现独特的抗生素与 IBD 发作风险增加显着相关。我们的研究结果得到了 GBDT 机器学习模型的证实。医疗保健提供者应意识到特定抗生素组对仅以限制性方式使用这些药物的 IBD 患者的潜在有害作用，或优先考虑替代抗生素组。