Abstract：
OBJECTIVE: The association between antibiotic exposure and inflammatory bowel disease (IBD) remains controversial, especially whether there is a dose-response relationship. We aimed to conduct a systematic review and meta-analysis to thoroughly evaluate the risk of new-onset IBD associated with antibiotic exposure.
METHODS: Four databases were searched from their inception to September 30, 2023 for all relevant studies. The risk estimates were pooled together using random-effects models, and pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated, stratified by IBD subtype, age, exposure period, study type, and antibiotic classes. Dose-response relationship between the number of antibiotic prescriptions and IBD risk was assessed using generalized least squares regression analysis.
RESULTS: Twenty-eight studies involving 153,027 patients with IBD were included. Antibiotic exposure was significantly associated with an increased risk of new-onset IBD for prescription-based studies (pooled OR, 1.41; 95% CI, 1.29-1.53) and for questionnaire-based studies (pooled OR, 1.35; 95% CI, 1.08-1.68). This association existed for both Crohn\'s disease and ulcerative colitis, as well as in children and adults for prescription-based studies. The majority of antibiotic classes were associated with an increased IBD risk, with metronidazole (OR, 1.70; 95% CI, 1.38-2.10) and quinolones (OR, 1.56; 95% CI, 1.37-1.77) having relatively higher risk estimates. A positive nonlinear dose-response association was observed between the number of antibiotic prescriptions and IBD risk.
CONCLUSIONS: Antibiotic exposure was significantly associated with an increased risk of new-onset IBD, and a positive nonlinear dose-response relationship was observed. Antibiotic stewardship may be important for reducing IBD risk.
METHODS: Four databases were searched from their inception to September 30, 2023 for all relevant studies. The risk estimates were pooled together using random-effects models, and pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated, stratified by IBD subtype, age, exposure period, study type, and antibiotic classes. Dose-response relationship between the number of antibiotic prescriptions and IBD risk was assessed using generalized least squares regression analysis.
RESULTS: Twenty-eight studies involving 153,027 patients with IBD were included. Antibiotic exposure was significantly associated with an increased risk of new-onset IBD for prescription-based studies (pooled OR, 1.41; 95% CI, 1.29-1.53) and for questionnaire-based studies (pooled OR, 1.35; 95% CI, 1.08-1.68). This association existed for both Crohn\'s disease and ulcerative colitis, as well as in children and adults for prescription-based studies. The majority of antibiotic classes were associated with an increased IBD risk, with metronidazole (OR, 1.70; 95% CI, 1.38-2.10) and quinolones (OR, 1.56; 95% CI, 1.37-1.77) having relatively higher risk estimates. A positive nonlinear dose-response association was observed between the number of antibiotic prescriptions and IBD risk.
CONCLUSIONS: Antibiotic exposure was significantly associated with an increased risk of new-onset IBD, and a positive nonlinear dose-response relationship was observed. Antibiotic stewardship may be important for reducing IBD risk.
摘要：
目的：抗生素暴露与炎症性肠病（IBD）之间的关联仍存在争议，尤其是是否存在剂量-反应关系。我们旨在进行系统评价和荟萃分析，以全面评估与抗生素暴露相关的新发IBD的风险。
方法：从开始到2023年9月30日搜索了四个数据库，以进行所有相关研究。使用随机效应模型将风险估计汇总在一起，并计算具有95%置信区间(CI)的合并比值比(OR)，按IBD亚型分层，年龄,暴露期,研究类型,和抗生素类。使用广义最小二乘回归分析评估抗生素处方数量与IBD风险之间的剂量反应关系。
结果：纳入28项研究，涉及153,027例IBD患者。对于基于处方的研究（汇总OR=1.41，95％CI1.29-1.53）和基于问卷调查的研究（汇总OR=1.35，95％CI1.08-1.68），抗生素暴露与新发IBD的风险增加显着相关。这种关联存在于克罗恩病和溃疡性结肠炎，以及儿童和成人的处方为基础的研究。大多数抗生素类别与IBD风险增加有关，甲硝唑（OR=1.70，95％CI1.38-2.10）和喹诺酮类药物（OR=1.56，95％CI1.37-1.77）具有相对较高的风险估计。在抗生素处方数量和IBD风险之间观察到正的非线性剂量反应关联。
结论：抗生素暴露与新发IBD的风险增加显著相关，并观察到正的非线性剂量-反应关系。抗生素管理对于降低IBD风险可能很重要。
方法：从开始到2023年9月30日搜索了四个数据库，以进行所有相关研究。使用随机效应模型将风险估计汇总在一起，并计算具有95%置信区间(CI)的合并比值比(OR)，按IBD亚型分层，年龄,暴露期,研究类型,和抗生素类。使用广义最小二乘回归分析评估抗生素处方数量与IBD风险之间的剂量反应关系。
结果：纳入28项研究，涉及153,027例IBD患者。对于基于处方的研究（汇总OR=1.41，95％CI1.29-1.53）和基于问卷调查的研究（汇总OR=1.35，95％CI1.08-1.68），抗生素暴露与新发IBD的风险增加显着相关。这种关联存在于克罗恩病和溃疡性结肠炎，以及儿童和成人的处方为基础的研究。大多数抗生素类别与IBD风险增加有关，甲硝唑（OR=1.70，95％CI1.38-2.10）和喹诺酮类药物（OR=1.56，95％CI1.37-1.77）具有相对较高的风险估计。在抗生素处方数量和IBD风险之间观察到正的非线性剂量反应关联。
结论：抗生素暴露与新发IBD的风险增加显著相关，并观察到正的非线性剂量-反应关系。抗生素管理对于降低IBD风险可能很重要。
