Background: Acid suppressants inhibit gastric acid secretion and disrupt the intestinal microbiome, but whether that facilitates colonization and infection with MDROs is unclear.
Study design: Systematic review and meta-analysis.
Setting: Observational studies searched from database through July 2019.
Synopsis: A total of 26 observational studies published during 1996-2019 with 29,382 patients were included in this meta-analysis. Of those, 24 studies directly measured intestinal MDRO carriage and 2 used urinary tract infections (UTIs) as the outcome measure, since most UTIs are caused by bacteria that colonize the intestinal tract. Target MDROs included multidrug-resistant Enterobacteriaceae (MRD-E) and vancomycin-resistant enterococci (VRE). Meta-analysis demonstrated that acid suppression is associated with increased odds of intestinal MDRO colonization (MDR-E: odds ratio, 1.60; 95% confidence interval, 1.33-1.92; VRE: OR, 1.97; 95% CI, 1.49-2.60), in both community and health care settings. The risk was similar for colonization with MDR-E and VRE. Regarding the effect of acid suppression by drug class, results were mixed with some studies demonstrating increased risk of MDRO in PPI users only while others reported increased risk only with H2-receptor antagonists.
Bottom line: Acid suppression therapy is associated with increased odds of MDRO colonization. While observational studies cannot prove causation, it is wise to avoid excessive use of acid suppressants.
Citation: Willems RPJ et al. Evaluation of the association between gastric acid suppression and risk of intestinal colonization with multidrug-resistant microorganisms: A systematic review and meta-analysis. JAMA Intern Med. 2020 Feb 24;180(4):561-71.
Dr. Li is assistant professor of medicine, section of hospital medicine, at the University of Virginia School of Medicine, Charlottesville.