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Concomitant PPI, antibiotic use associated with prolonged CPE colonization
The use of antibiotics accompanied by proton pump inhibitors was associated with prolonged gastrointestinal colonization by carbapenemase-producing Enterobacteriaceae, researchers in China determined.
“It is important to prevent importation and nosocomial transmission of carbapenemase-producing Enterobacteriaceae (CPE) in our health care settings through the implementation of proactive infection control measures and to understand the risk factors for CPE acquisition, such as recent hospitalization and the presence of indwelling devices,” Vincent C.C. Cheng, MD, of the department of microbiology at Queen Mary Hospital, Hong Kong, and colleagues wrote. “Unexpectedly, the use of proton pump inhibitors (PPI) was independently associated with fecal colonization and carriage duration of CPE. The finding is important for the formulation of infection control policy.”
The researchers analyzed fecal specimens from 31,526 patients in the Hong Kong West Hospital Network, identifying those with GI CPE colonization (n = 100). Sixty-nine of the colonized patients were male (median age, 60 years). Of the total cohort, 37 patients had nosocomial CPE onset, 21 of whom had been detected from opportunistic and safety net screening on different wards. There was no evidence to suggest a hospital outbreak, Cheng and colleagues reported.
Seventy-nine patients from the original cohort provided more than one specimen for the study, with CPE spontaneously clearing in 57 patients (median time, 30 days) during a median follow-up of 33 days.
Several significant risk factors for CPE were identified using multivariable analysis, including male sex (OR = 1.91; 95% CI, 1.15-3.18); presence of a wound or drain (OR = 3.12; 95% CI, 1.7-5.71); and the use of cephalosporins (OR = 3.06; 95% CI, 1.42-6.59); carbapenems (OR = 2.21; 95% CI, 1.1-4.48); and PPI (OR = 2.84; 95% CI, 1.72-4.71) in the previous 6 months. The concomitant use of PPI and antibiotics was associated with prolonged colonization of CPE (HR = 0.35; 95% CI, 0.17-0.73) vs. patients who did not use the treatments concomitantly.
Cheng and colleagues noted that the study’s small sample size may not be enough to identify other significant associations.
“However, we believe that the analysis of the clinical epidemiology in this group of patients provides useful information for the formulation of infection control policy, regardless of the actual molecular type of CPE,” they wrote. “In summary, compliance with infection control and hand hygiene is particularly important for relevant health care workers and patients on concomitant treatment with antibiotics and PPI, which predispose them to a more prolonged carriage of CPE.” – by Andy Polhamus
Disclosure: The researchers report no relevant financial disclosures.