Exposure to common nonantimicrobial drugs may lead to drug-resistant infections
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Exposure to commonly prescribed nonantimicrobial drugs was associated with an increased risk for drug-resistant infections in a study of more than 1,800 patients at an Israeli hospital, researchers reported at the ECCMID virtual meeting.
Three classes of drugs — proton pump inhibitors, beta-blockers and antimetabolites — were significantly associated with resistance to antibiotics commonly used to treat UTIs and other infections caused by gram-negative bacteria, said Meital Elbaz, MD, a physician at Tel Aviv Medical Center.
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“Infections with drug-resistant gram‐negative bacteria have increased significantly in recent years, with infections caused by these organisms often more prevalent than gram‐positive infections in many settings,” Elbaz told Healio. “The growing risk of antimicrobial resistance among gram‐negative bacteria is a worldwide problem due to the potential for rapid spread of resistance mechanisms and limited treatment options.”
According to Elbaz, while some commonly used nonantimicrobial drugs have been linked to changes in the gut microbiome, the role they may play in acquiring drug-resistant bacteria has not been systematically studied.
For their study, Elbaz and colleagues examined data from 1,807 adults admitted to the hospital between Jan. 1, 2017, and April 18, 2019, with a UTI and a positive urine or blood culture growing Enterobacteriaceae.
According to Elbaz, they retrieved records of prior use of 22 nonantimicrobial drug classes before hospital admission from patients’ electronic medical records.
The researchers identified antimicrobial drug-resistant organisms in more than half of patient samples (944/1,807). They identified multidrug-resistant organisms that were resistant to three or more classes of antibiotics in nearly one in every four episodes (431/1,807).
Their analyses found that the use of seven common drug categories was associated with increased resistance to antimicrobial drugs — selective serotonin reuptake inhibitors, typical antipsychotics, anticoagulants apixaban and rivaroxaban, proton pump inhibitors (PPIs), beta-blockers, clopidogrel and antimetabolites.
PPIs, beta-blockers and antimetabolites were significantly associated with resistance to third-generation cephalosporins, trimethoprim-sulfamethoxazole, and fluoroquinolones.
“Our findings emphasize the importance of nonantimicrobial drug exposure as a risk factor for antibiotic resistance, and previous exposure to these drugs may help physicians in the future while choosing empirical therapy, although further research on larger datasets is required,” Elbaz said.
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Elbaz M, et al. Exposure to non-antimicrobial drugs and risk of urinary tract infection with drug-resistant Enterobacteriaceae. Presented at ECCMID; July 9-12, 2021 (virtual meeting).
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