The many microbial effects of proton pump inhibitors

We have written frequently about the many health care acquired infections and multi-drug resistant organisms that have been linked to proton pump inhibitor use, including ventilator association pneumonia, community acquired pneumonia, health care associated pneumonia in non-ICU settings, spontaneous bacterial peritonitis in patients with cirrhosis, and, of course, Clostridium difficile. In the U.S., proton pump inhibitors are the third most prescribed medication, they are addictive because 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 two days. The cross-section study just published in Clinical Infectious Diseases (free full text) linked rectal carriage of extended spectrum beta-lactamase–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 proton pump inhibitor 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, proton pump inhibitor swere associated with four times the risk of extended spectrum beta-lactamase rectal carriage. (OR 3.89; 95% CI, 1.65 to 9.19). This is a very nicely completed study and provides more evidence supporting the inclusion of proton pump inhibitors targets in our “antimicrobial” stewardship programs.

Eli N. Perencevich, MD, ACP Member, is an infectious disease physician and epidemiologist in Iowa City, Iowa, who studies methods to halt the spread of resistant bacteria in our hospitals (including novel ways to get everyone to wash their hands). This post originally appeared at the blog Controversies in Hospital Infection Prevention.