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.

The Year in Infection Control: Almost Live from ECCMID 2012

Jan Kluytmans and Maria Luisa Moro were kind enough to share their presentation from ECCMID in London earlier this month.  What a great review - wish I was there. Enjoy! The Year in Infection Control

New #OpenAccess Antimicrobial Resistance and Infection Control (ARIC) Journal Publishes First Papers

Andreas Voss, Jan Kluytmans and Didier Pittet have successfully started a new international, open-access journal called Antimicrobial Resistance and Infection Control (ARIC). The first batch of papers were just posted today to the ARIC website.  This event is a significant for several reasons.

The first, as I've mentioned before, is that as an open-access journal, ARIC will allow unaffiliated scientists, the general public and otherwise interested parties free full access immediately upon publication without having to wait years or pay high fees. In an editorial, accompanying the first publications, the editors highlight their views of open access including how they hope to respond to the high initial costs for authors.

They write: "ARIC's choice of "open-access" is a logical step towards its goal to be truly international and to allow the transfer of knowledge and best practices to even remote places that cannot afford printed journals. We realize that open access has financial consequence for some authors and that the standard BioMed Central rules to waive article-processing charges may not be enough. BioMed Central provides an automatic waiver to authors based in any country classified by the World Bank as low-income or lower-middle-income economies, but we intend to find solutions in the near future that will allow us to support authors from upper-middle income countries and young investigators" 

The second and I think equally important reason that ARIC's emergence is important is that we've never had an international voice in infection control. As the 1200 attendees from 84 countries at last summers ICPIC meeting can attest, international collaboration will be the key for controlling antimicrobial-resistant bacterial pathogens (think NDM-1) in the future.


I wish the editors and the ARIC journal much luck and future success!

@eliowa