Proton Pump Inhibitors and ESBL

We have written frequently about the many HAI and MDRO that have been linked to PPI use including VAP, CAP, HAP in non-ICU settings, SBP in patients with cirrhosis, and, of course, C. difficile. In the US, PPIs are the third most prescribed medication, they are addictive since withdrawal symptoms can develop and are now available over-the-counter.

Researchers at Amphia Hospital, an 850-bed teaching facility in the Netherlands, completed two prevalence studies (November 2014 and 2015) on all adult patients who had stayed for no more than 2 days. The cross-section study just published in CID (free full text) linked rectal carriage of ESBL-producing Enterobacteriaceae to pre-admission use of PPI and H2-antagonists among other factors.

Rectal cultures were available from 570 patients and 259 (45%) had a history of PPI use, while very few used H2-blockers or antacids. I have included the univariable and multivariable analyses below. More than concurrent antibiotic use or prior hospital admission, PPIs were associated with four times the risk of ESBL rectal carriage. (OR 3.89, 95% CI 1.65-9.19).  This is a very nicely completed study and provides more evidence supporting the inclusion of PPIs targets in our "antimicrobial" stewardship programs.


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