Gastric acid suppression, lifestyle factors and intestinal carriage of ESBL and carbapenemase-producing Enterobacterales: a nationwide population-based study

Abstract

Background Gastric acid-suppressive therapy has been suggested to increase the risk for intestinal carriage of MDR Enterobacterales, but there is scarce community-based evidence substantiating this risk. Objectives To investigate if acid-suppressant use is associated with a risk of intestinal carriage of ESBL and carbapenemase-producing Enterobacterales (ESBL-E) in the open population, and to assess possible modifying factors. Methods Within the framework of a nationwide seroprevalence study, we identified a population-based cross-sectional cohort comprising 2746 adults (≥18 years), who provided stool specimens between February 2016 and June 2017. Specimens were tested by phenotypic assays and confirmatory genotype analysis to detect carriage of ESBL-E. Covariate data were extracted from self-administered questionnaires. ORs and 95% CIs were estimated using multivariable multilevel logistic regression, controlling for confounders informed by directed acyclic graphs. Results Among 2746 participants, 316 (11.5%) used acid suppressants; the prevalence of ESBL-E carriage was 7.4% (95% CI, 6.1%–8.6%). Current use of acid suppressants was not associated with ESBL-E carriage (adjusted OR [aOR], 1.05; 95% CI, 0.64–1.74); lifestyle and comorbidity did not modify this association. A higher BMI (≥25 kg/m2) (aOR, 1.42 [95% CI, 1.02–1.98]), non-Western ethnic origin (aOR, 1.96 [95% CI, 1.34–2.87]), travel to Eastern-Mediterranean, Western-Pacific or South-East Asia regions (aOR, 3.16 [95% CI, 1.71–5.83]) were associated with ESBL-E carriage. Sensitivity analyses confirmed these results; spline analysis supported a BMI-associated risk. Conclusions In this open population study, current use of acid suppressants was not associated with ESBL-E carriage. Travel to high-endemic regions and non-Western ethnicity were confirmed as risk factors, while a higher BMI emerged as a potential new risk for ESBL-E carriage.

Incidence and predictors of Escherichia coli producing extended-spectrum beta-lactamase (ESBL-Ec) in Queensland, Australia from 2010 to 2019: a population-based spatial analysis

“…Nonetheless, a population-based prevalence study was recently conducted in the Netherlands investigating predictors of ESBL-producing Enterobacterales carriage as compared to non-carriers in the community. Consistent with our results, this study also reported that population density was not predictive of higher incidence [ 21 ]. Although a mathematical modelling study had suggested that the probability of ESBL-Ec transmission could be higher within denser households, transmission can be attenuated with good hand hygiene practices [ 22 ].…”

“…Another limitation in our study is that healthcare-associated risk factors, such as community consumption of antibiotics and hospital exposure, were not accounted in the analyses. While modelling studies have predicted that reducing overall antibiotic use could reduce drastically ESBL-producing bacteria colonisation [ 30 ], other population-based studies have reported that these predictors were not significantly associated with or had limited contribution to ESBL-Ec incidence in the community [ 10 , 21 ]. These healthcare-associated risk factors may account for some of the residual spatially structured effects detected in the Brisbane city area, where accessibility to antibiotics and medical care is higher as compared to remote areas.…”

Intestinal colonization with multidrug-resistant Enterobacterales: screening, epidemiology, clinical impact, and strategies to decolonize carriers

“…With regard to the risk factors for people in the community, in some studies, regular contact with children and animals, and consumption of contaminated food (e.g., meat products and aquatic food) have been identified as risk factors for acquiring MDR-Ent [99,100,105,106,[111][112][113][114]. More importantly, international travel (see below), previous hospitalization, and general health status (e.g., underlying disease, extreme age group, body mass index ≥ 25 kg/m 2 ) are significantly associated with the carriage of MDR bacteria (e.g., [67,111,115]). For instance, HIV-positive individuals are at increased risk for acquiring MDR-Ent [116].…”

Gut colonisation by extended-spectrum β-lactamase-producing Escherichia coli and its association with the gut microbiome and metabolome in Dutch adults: a matched case-control study

“…Details of the microbiological methods have been described elsewhere 15 and are summarised in the appendix (p 2).…”