February 24, 2020
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Acid suppression linked with multidrug-resistant microorganism colonization

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Acid-suppression medication may increase the odds for colonization by multidrug-resistant microorganisms, according to a meta-analysis published in JAMA Internal Medicine.

Roel P.J. Willems, MD, of the department of medical microbiology and infection at Amsterdam UMC, and colleagues wrote that use of acid suppressors is on the rise, with proton pump inhibitor use alone doubling in the United States between 1999 and 2012. This has led to concerns about how these drugs alter the gut microbiome.

“Whether acid suppression facilitates colonization and infection with [multidrug-resistant microorganisms (MDROs)] remains unclear,” they wrote. “Current evidence from observational studies has been inconsistent, considering that some epidemiologic studies report an increased risk of MDRO colonization with acid suppression, whereas others do not demonstrate such an association.”

Researchers searched the literature for observational studies and clinical trial designs that quantified the risk for MDRO colonization in individuals who used acid suppressants compared with nonusers. The primary outcome measure was intestinal colonization with MDROs, including the order Enterobacterales, vancomycin-resistant enterococci, methicillin-resistant or vancomycin-resistant Staphylococcus aureus, or multidrug-resistant Pseudomonas or Acinetobacter.

Willems and colleagues identified 26 observational studies that fit their criteria comprising 29,382 patients, including 11,439 who used acid suppressants.

In their primary meta-analysis that included 12 studies and 22,305 patients, researchers found that acid suppression increased the odds of intestinal carriage of Enterobacterales and vancomycin-resistant enterococci (OR = 1.74; 95% CI, 1.4-2.16). In a pooled analysis of all 26 studies, the findings were consistent (OR = 1.7; 95% CI, 1.44-1.99).

Willems and colleagues wrote that their findings should be viewed with some caution because the studies were observational. However, they could provide some insight into appropriate acid suppressant use.

“In view of the ever-growing problem of antimicrobial resistance, we see the possibility of a favorable interaction between infection control, antibiotic stewardship and the promotion of ration use of PPIs,” they wrote. “This rational use could be called PPI stewardship. Future intervention programs may provide further insight about whether the risks of MDRO colonization and infection are reduced after discontinuation of inappropriate acid suppression therapy.” – by Alex Young

Disclosure: The authors report no relevant financial disclosures.