Association of Proton Pump Inhibitor Use With Risk of Acquiring Drug-Resistant Enterobacterales

Area of Science:

• Infectious Diseases
• Pharmacology
• Microbiology

Background:

• Proton pump inhibitors (PPIs) are linked to drug-resistant bacteria colonization, but confounding factors and dose-dependency remain unclear.
• Understanding the association between PPIs and resistant Enterobacterales is crucial for patient safety.

Purpose of the Study:

• To evaluate the association between proton pump inhibitor (PPI) use and the risk of acquiring drug-resistant Enterobacterales.
• To investigate potential interactions between PPIs and other microbiome-altering agents.

Main Methods:

• A nested case-control study of 2239 hospitalized adult patients was conducted.
• Patients with new ESBL- or carbapenemase-producing Enterobacterales were cases; controls were matched by age and culture date.
• Conditional logistic regression models estimated adjusted incidence rate ratios (aIRRs) for PPI exposure.

Main Results:

• PPI use was associated with an increased risk of acquiring ESBL- or carbapenemase-producing Enterobacterales (aIRR, 1.48 at 30 days).
• Validation studies and sensitivity analyses confirmed these findings.
• Laxatives and antibiotics, but not other microbiome-altering agents, were independently associated with increased acquisition risk.

Conclusions:

• Proton pump inhibitor use is associated with an increased risk of acquiring drug-resistant Enterobacterales in hospitalized adults.
• These findings highlight the importance of judicious PPI prescribing to mitigate risks.
• Further research may explore mechanisms and optimal management strategies.