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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.
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Background: Community-acquired urinary tract infection (UTI) is the most common infection caused by extended-spectrum beta-lactamase (ESBL)-producing organisms. Aim: to estimate the prevalence of ESBL-UTI in adults and to identify potential risk factors that may predispose to ESBL-UTI. Methods: A retrospective study involving adult patients with UTI caused by ESBL-producing organisms was undertaken. Patients with UTI caused by non-ESBL-producing organisms represented the control group. Results: In total, 1100 UTI isolates were included in the study, 277 of which were ESBL positive. The prevalence rate was 25.2%. The mean age of patients was 55.87 years. On univariate analysis, prior history of UTI or ESBL-UTI, invasive urological procedure within preceding 3 months, hospital admission within preceding 3 months, and exposure to antibiotics were found to be significant risk factors for ESBL-UTI. On multi-variate analysis, use of cephalosporins [adjusted odds ratio (OR) 1.61, P=0.048], previous ESBL-UTI (adjusted OR 2.67, P<0.001), and invasive urological procedure in the preceding year (adjusted OR 1.61, P=0.022) were found to be independent risk factors for ESBL-UTI. Conclusions: In Qatar, the prevalence of ESBL-UTI in adults is modest. Recent exposure to antibiotics, previous ESBL-UTI and invasive urological procedures were found to be independent risk factors for ESBL-UTI.
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Brucellosis, is a zoonosis infection with a planetary distribution, caused by facultative intracellular bacteria of the genus Brucella, thus has a variable clinical presentation. Spinal epidural abscesses are a rare presentation of the disease, and may carry risk of a neurovascular compromise. Here we report a 22-year-old male with spinal brucellosis complicated by a cervical epidural abscess. The diagnosis was based on presenting symptoms and his occupation, confirmed by laboratory investigations, blood culture and magnetic resonance imaging results. Surgical drainage of abscess was performed, followed by 6 weeks of combination antibiotic therapy. The combination of the therapeutic strategies we used lead to a significant clinical improvement in this rare case.