A Novel Risk Factor Associated With Colonization by Carbapenemase-Producing Enterobacteriaceae: Use of Proton Pump Inhibitors in Addition to Antimicrobial Treatment

Abstract

OBJECTIVETo study the association between gastrointestinal colonization of carbapenemase-producing Enterobacteriaceae (CPE) and proton pump inhibitors (PPIs).METHODSWe analyzed 31,526 patients with prospective collection of fecal specimens for CPE screening: upon admission (targeted screening) and during hospitalization (opportunistic screening, safety net screening, and extensive contact tracing), in our healthcare network with 3,200 beds from July 1, 2011, through December 31, 2015. Specimens were collected at least once weekly during hospitalization for CPE carriers and subjected to broth enrichment culture and multiplex polymerase chain reaction.RESULTSOf 66,672 fecal specimens collected, 345 specimens (0.5%) from 100 patients (0.3%) had CPE. The number and prevalence (per 100,000 patient-days) of CPE increased from 2 (0.3) in 2012 to 63 (8.0) in 2015 (P<.001). Male sex (odds ratio, 1.91 [95% CI, 1.15–3.18], P=.013), presence of wound or drain (3.12 [1.70–5.71], P<.001), and use of cephalosporins (3.06 [1.42–6.59], P=.004), carbapenems (2.21 [1.10–4.48], P=.027), and PPIs (2.84 [1.72–4.71], P<.001) in the preceding 6 months were significant risk factors by multivariable analysis. Of 79 patients with serial fecal specimens, spontaneous clearance of CPE was noted in 57 (72.2%), with a median (range) of 30 (3–411) days. Comparing patients without use of antibiotics and PPIs, consumption of both antibiotics and PPIs after CPE identification was associated with later clearance of CPE (hazard ratio, 0.35 [95% CI, 0.17–0.73], P=.005).CONCLUSIONSConcomitant use of antibiotics and PPIs prolonged duration of gastrointestinal colonization by CPE.Infect Control Hosp Epidemiol 2016;1418–1425

Evaluation of the Association Between Gastric Acid Suppression and Risk of Intestinal Colonization With Multidrug-Resistant Microorganisms

“…In the primary analysis, we included the 12 studies that adjusted for confounding. [8][9][10]37,39,40,43,45,47,54,55,57 This showed that acid suppression was associated with MDRO colonization (OR = 1.74; 95% CI, 1.40-2.16) ( Figure 2). Among these studies, heterogeneity, as measured using the I 2 method, was 68%.…”

“…[8][9][10]15, Among these 26 studies, 2 clinical studies of interventions not related to the use of acid suppressants were included as cohort studies because no intervention effect was found and they included the analysis of exposure to ac id suppressants as a covariate. 5 0 , 5 3 A total of 24 studies measured intestinal carriage, 19 of MDR-E [8][9][10]15,36,37,39,[42][43][44][45][46]48,49,51,52,54,56,57 and 7 of vancomycinresistant enterococci (VRE). 38,40,41,47,50,53,55 Additionally, 2 studies had UTI as the outcome measure.…”

“…[8][9][10]37,39,40,43,45,47,54,55,57 Overall, the 12 studies included 22 305 participants (8491 [38.1%] were acid suppressant users; 12 714 [57.0%] were female). Of these, 7 studies were cross-sectional, 9,10,37,43,45,55,57 3 were case control, 39,40,54 and 2 were cohort studies. 8,47 We summarized the study characteristics in the Table. Studies were published between 1996 and 2019; most were of adult populations (age ≥18 years).…”

“…8,47 We summarized the study characteristics in the Table. Studies were published between 1996 and 2019; most were of adult populations (age ≥18 years). Three studies were designed to determine the risk assoc iated w ith ac id suppressants, 9,39,54 whereas the remaining studies evaluated risk factors in general. Most studies were conducted in the World Health Organization European region (13 of 26 studies) and the region of the Americas (11 of 26 studies) (eTable 1 in the Supplement).…”

Role of Hand Hygiene Ambassador and Implementation of Directly Observed Hand Hygiene Among Residents in Residential Care Homes for the Elderly in Hong Kong

“…7 , 19 We did not screen for VRE and CPE because of its low prevalence in our RCHE. 7 , 20 For each sponge swab, 2mL sterile normal saline (0.85% sodium chloride) was added to the sterile plastic bag. The sponge was squeezed repeatedly for proper mixing, then 100 μL suspension was transferred from the bag for processing as previously described.…”