Purayil Nishan Kunnummal, Naushad Vamanjore A, Chandra Prem, Joseph Prakash, Khalil Zahida, Zahid Muhammad, Wilson Godwin, Kayakkool Muhammed Kunhi, Ayari Basma, Chalihadan Sajid, Elmagboul Emad Bashier I, Doiphode Sanjay H
General Internal Medicine Department, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
Clinical Department, College of Medicine-QU Health, Qatar University, Doha, Qatar.
Infect Drug Resist. 2023 Jun 29;16:4251-4258. doi: 10.2147/IDR.S415096. eCollection 2023.
To study the association between proton pump inhibitor (PPI) use and the risk of urinary tract infection (UTI) caused by extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL).
A retrospective cross-sectional study was conducted between October 2018 and September 2019. Adults with ESBL-UTIs were compared to adults with UTIs caused by gram-negative bacteria (GNB) and those with UTIs caused by miscellaneous organisms. The association between ESBL infection and PPI use was assessed.
A total of 117 of 277 ESBL cases, 229 of 679 non-ESBL GNB controls, and 57 of 144 non-ESBL miscellaneous controls were exposed to PPIs within 3 months prior to admission. The univariate analysis indicated unadjusted odds ratio for PPI exposure with ESBL infection versus the GNB controls was 1.43 (95% CI 1.07-1.90, P = 0.015) while the odds ratio for PPI exposure with ESBL infection versus miscellaneous organisms was 1.10 (95% CI 0.73-1.67, P = 0.633) indicating positive association (PPI exposure increases risk of ESBL infection). Multivariate analysis revealed a positive association between ESBL infection and PPI use versus the GNB controls with an odds ratio of 1.74 (95% CI 0.91-3.31). While Esomeprazole was positively associated with ESBL infection, particularly compared with the miscellaneous group (adjusted OR 1.35, 95% CI 0.47-3.88), Lansoprazole was inversely associated (adjusted OR 0.48, 95% CI 0.18-1.24 and adjusted OR 0.40, 95% CI 0.11-1.41 for ESBL versus GNB controls and ESBL versus miscellaneous organisms, respectively).
Exposure to PPIs in the preceding 3 months showed an association with increased risk of ESBL-UTI. While Esomeprazole showed a positive association, Lansoprazole had an inverse association for ESBL-UTI. Restricting the use of PPIs may be beneficial in the fight against antimicrobial resistance.
研究使用质子泵抑制剂（PPI）与产超广谱β-内酰胺酶肠杆菌科细菌（ESBL）所致尿路感染（UTI）风险之间的关联。
于2018年10月至2019年9月进行了一项回顾性横断面研究。将患有ESBL-UTI的成年人与由革兰氏阴性菌（GNB）引起UTI的成年人以及由其他微生物引起UTI的成年人进行比较。评估ESBL感染与PPI使用之间的关联。
在277例ESBL病例中，有117例、679例非ESBL GNB对照中有229例、144例非ESBL其他对照中有57例在入院前3个月内使用过PPI。单因素分析表明，ESBL感染患者使用PPI与GNB对照相比，未调整的优势比为1.43（95%可信区间1.07 - 1.90，P = 0.015），而ESBL感染患者使用PPI与其他微生物相比的优势比为1.10（95%可信区间0.73 - 1.67，P = 0.633），表明存在正相关（PPI使用增加ESBL感染风险）。多因素分析显示，ESBL感染与使用PPI相比GNB对照之间存在正相关，优势比为1.74（95%可信区间0.91 - 3.31）。虽然埃索美拉唑与ESBL感染呈正相关，特别是与其他微生物组相比（调整后OR 1.35，95%可信区间0.47 - 3.88），但兰索拉唑呈负相关（ESBL与GNB对照以及ESBL与其他微生物相比，调整后OR分别为0.48，95%可信区间0.18 - 1.24和调整后OR 0.40，95%可信区间0.11 - 1.41）。
在之前3个月内使用PPI与ESBL-UTI风险增加有关。虽然埃索美拉唑显示出正相关，但兰索拉唑与ESBL-UTI呈负相关。限制PPI的使用可能有助于对抗抗菌药物耐药性。
