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PROTON-PUMP INHIBITOR USE AND RISK OF BLOODSTREAM INFECTION SECONDARY TO BACTERIAL TRANSLOCATION

SHINTARO HAYASHI 1, Tomohito Moriyama 1, Yuichiro Ito 1, Yuta Harada 1, Hiroki Dodo 1, Kana Kumahara 1, Tatsuji Yogi 1, Noritsugu Ohashi 1, Reiji Higashi 1, Akihiro Mori 1

Affiliations

1 Ichinomiya-Nishi Hospital, Ichinomiya, Japan

Summary

AI Generated

A hospital-based case-control study found that proton-pump inhibitor use was associated with a 2.4-fold increased risk of bloodstream infections without an identifiable infectious focus, suggesting a possible link to bacterial translocation in non-cirrhotic patients.

Among 309 hospitalized patients with bloodstream infections, those receiving proton-pump inhibitor therapy at infection onset had an adjusted odds ratio of 2.41 (95% CI: 1.29–4.51) for developing bloodstream infections without an identifiable focus compared to non-users.
The study enrolled 66 cases with bacterial translocation-type bloodstream infections and 243 controls from a single hospital in 2019, with 49% of all patients receiving continuous proton-pump inhibitor therapy.
The association remained statistically significant (p=0.006) after controlling for age, sex, Charlson Comorbidity Index, liver cirrhosis, active gut disease, and infection onset location, and sensitivity analyses confirmed the findings.
The authors conclude that proton-pump inhibitor use may increase the risk of septic morbidity secondary to bacterial translocation, extending prior findings in cirrhotic patients to a broader hospitalized population.

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This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Abstract

Introduction

Pathogens can translocate from the gut lumen to the systemic circulation while gut microbiota play an important role in maintaining an immunologically balanced inflammatory response and protecting against colonisation by invasive pathogens. Studies showed that among people with liver cirrhosis, proton-pump inhibitor (PPI) users had a higher risk of spontaneous bacterial peritonitis (SBP). It has been hypothesised that PPI use can facilitate small intestinal bacterial overgrowth and related intestinal dysbiosis that lead to dysregulated bacterial translocation and subsequent SBP. However, the link between PPI use and systemic infectious complications secondary to bacterial translocation in non-cirrhotic patients is unclear.

Aims & Methods

This study aimed to investigate whether patients receiving PPI therapy have a higher risk for bloodstream infections (BSI) without an identifiable infectious focus, as an alternative indicator of BSI secondary to bacterial translocations. We conducted a hospital-based case–control study which enrolled all patients aged 20 years and older who developed BSI confirmed by two sets of positive blood culture and had inpatient care in Ichinomiya-Nishi Hospital in 2019. Patients’ data were collected from medical records, and bacterial translocation type (BT-type) BSI group were defined as those who had BSI without an identifiable focus of infection, whereas the others were classified control group. PPI use at BSI onset was considered the primary exposure of interest. To control for factors that were potentially associated with both PPI use and BSI, we retrieved data on the several factors and examined the potential confounders by using the Mantel–Haenszel stratified analyses. Logistic regression yielded adjusted odds ratios (OR) and 95% confidence intervals (CI) for BT-type BSI among PPI users and non-users. To address the possibility of outcome misclassification, we also conducted sensitivity analyses.

Results

We analysed data from 309 patients, including 66 cases (BT-type BSI group) and 243 controls. 152 patients (49%) were receiving continuous PPI therapy at BSI onset. The mean age was 78 years in both cases and controls. Patients on PPI therapy had a 2.4-fold higher risk of developing BT-type BSI compared to non-PPI-users after controlling for age, sex, the Charlson Comorbidity Index, liver cirrhosis, active gut disease, and onset location (OR: 2.41, 95% CI: 1.29–4.51). After adjustment, an association of PPI use with BT-type BSI (p=0.006) was observed. The results of the sensitivity analyses were consistent with the primary analysis.

Conclusion

PPI use is associated with higher risk of BSI without an identifiable infectious focus and therefore, PPI use may increase the risk of septic morbidity secondary to bacterial translocation.

References

1. MacFie J, O'Boyle C, Mitchell CJ, et al. Gut origin of sepsis: a prospective study investigating associations between bacterial translocation, gastric microflora, and septic morbidity. Gut 1999;45:223–8.
2. Alhumaid S, Al Mutair A, Al Alawi Z, et al. Proton pump inhibitors use and risk of developing spontaneous bacterial peritonitis in cirrhotic patients: A systematic review and meta-analysis. Gut Pathog 2021;13:17.
3. Lombardo L, Foti M, Ruggia O, et al. Increased incidence of small intestinal bacterial overgrowth during proton pump inhibitor therapy. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association. 2010;8(6):504-8.

Disclosure

Nothing to disclose

Conference

UEG Week Copenhagen 2023

Topics

Small Intestine & Nutrition

Submission format

Abstract

Session

PP 03 Small intestinal (Posters)

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

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