Antacid use linked to higher risk for colonization with multidrug-resistant organisms

  • Willems RPJ & al.
  • JAMA Intern Med
  • 24 Feb 2020

  • curated by Jenny Blair, MD
  • Clinical Essentials
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Takeaway

  • 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.

Key results

  • 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. 

Study design

  • 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.

Limitations

  • No controlled trials found.
  • No studies of methicillin- or of vancomycin-resistant Staphylococcus aureus.
  • Substantial heterogeneity.