- Careful stewardship of acid suppressants may help to curb intestinal colonization by multidrug-resistant microorganisms (MDROs).
- Authors: “We advocate that acid suppressants should be used when necessary but that unnecessary use should be avoided.”
Why this matters
- Acid suppressants are widely available, many without a prescription.
- Up to 70% of proton pump inhibitor use is inappropriate.
- With acid suppressant use vs without, OR (95% CIs) of colonization with:
- MDROs: 1.74 (1.40-2.16).
- Multidrug-resistant Enterobacterales (MDR-E): 1.60 (1.33-1.92).
- Vancomycin-resistant enterococci: 1.97 (1.49-2.60).
- Carbapenem-producing MDR-E: 2.04 (1.34-3.10).
- Extended-spectrum β-lactamase-producing MDR-E: 1.43 (1.20-1.70).
- Similar results upon sensitivity analyses.
- No evidence of publication bias.
- Systematic review of 26 observational studies, including meta-analysis of 12 (n>22,000), comparing MDRO colonization risk in acid-suppressant users vs nonusers (n=29,382).
- Authors excluded studies of Clostridium difficile colonization.
- They included studies of urinary tract infection.
- Outcomes: colonization of the gut by any of several drug-resistant bacterial types.
- Funding: Netherlands Organization for Health Research and Development.
- No controlled trials found.
- No studies of methicillin- or of vancomycin-resistant Staphylococcus aureus.
- Substantial heterogeneity.