Psychoactive drug prescription and urine colonization with extended-spectrum β-lactamase-producing Enterobacteriaceae

Background: The worldwide dissemination of extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae has become a major health concern. Previous studies have shown that psychoactive drugs have intrinsic antimicrobial activity and may play a role in the dissemination of antibiotic resistance. The objective of this study was to assess the association between prescriptions for psychoactive drug and urine colonization with ESBL-producing Enterobacteriaceae. Subjects: Ninety-five patients were included; 19 cases (urine colonization with an ESBL-producing Enterobacteriaceae) and 76 controls (urine colonization with non ESBL-producing Enterobacteriaceae); and were matched for age and gender. Methods: A retrospective 1:4 matched case-control study design was used. All patients colonized with an Enterobacteriaceae isolate in Nantes University Hospital from March to November 2014, were screened before inclusion in the study. Prescriptions data for psychoactive drugs were collected from the electronic medical records. Univariate and multivariate conditional logistic regression analyses were performed. Results: Thirty-seven patients (38.9%) were treated with psychoactive drugs, of whom 10 (52.6%) were in the ESBL-producing group and 27 (35.5%) were in the non-ESBL group. Mean (SD) age was 71.2 (23.1) years. In multivariate analyses, previous antimicrobial therapy within 6 months (OR=7.12, 95% CI 1.15-44.18; p=0.035) and previous colonization with an ESBL-producing organism (OR=44.87, 95% CI 1.26-1594.19; p=0.037) were associated with urine colonization with ESBL-producing Enterobacteriaceae. Conclusions: Our findings revealed that a history of previous antimicrobial therapy and previous colonization with ESBL-producing organisms are important risk factors in an elderly population. Psychoactive drugs were not associated with urinary carriage of ESBL-producing Enterobacteriaceae. Further studies are required to explore the relationship between psychoactive drugs and colonization with ESBL-producing Enterobacteriaceae.