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. 2023 Jun 29:16:4251-4258.
doi: 10.2147/IDR.S415096. eCollection 2023.

Association Between Proton Pump Inhibitor Use and Extended-Spectrum Beta-Lactamase Urinary Tract Infection in Adults: A Retrospective Study

Nishan Kunnummal Purayil  1   2   3 , Vamanjore A Naushad  1   2   3 , Prem Chandra  4 , Prakash Joseph  1   2 , Zahida Khalil  1   2 , Muhammad Zahid  1   3 , Godwin Wilson  3   5 , Muhammed Kunhi Kayakkool  1   2   3 , Basma Ayari  1   3 , Sajid Chalihadan  1 , Emad Bashier I Elmagboul  5 , Sanjay H Doiphode  3   5
Affiliations

Association Between Proton Pump Inhibitor Use and Extended-Spectrum Beta-Lactamase Urinary Tract Infection in Adults: A Retrospective Study

Nishan Kunnummal Purayil et al. Infect Drug Resist. .

Abstract

Purpose: 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).

Patients and methods: 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.

Results: 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).

Conclusion: 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.

Keywords: ESBL; PPI; extended-spectrum beta-lactamase; proton pump inhibitor; urinary tract infections.

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Conflict of interest statement

The authors declare that they have no financial interest or other conflict of interest to declare in this study.

Figures

Figure 1
Figure 1
(A) Distribution of ESBL organisms (n = 277). (B) Distribution of Non ESBL -GNB organisms (n = 679). (C) Distribution of Non ESBL- Miscellaneous organism (n = 144).
See this image and copyright information in PMC

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