title: Association between use of proton pump inhibitors and non-typhoidal salmonellosis identified following investigation into an outbreak of Salmonella Mikawasima in the UK, 2013.
abstract: In November 2013, national public health agencies in England and Scotland identified an increase in laboratory-confirmed Salmonella Mikawasima. The role of proton pump inhibitors (PPIs) as a risk factor for salmonellosis is unclear; we therefore captured information on PPI usage as part of our outbreak investigation. We conducted a case-control study, comparing each case with two controls. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were estimated using multivariable logistic regression. Thirty-nine of 61 eligible cases were included in the study. The median age of cases was 45 years; 56% were female. Of these, 33% were admitted to hospital and 31% reported taking PPIs. We identified an association between PPIs and non-typhoidal salmonellosis (aOR 8·8, 95% CI 2·0-38·3). There is increasing evidence supporting the existence of an association between salmonellosis and PPIs; however, biological studies are needed to understand the effect of PPIs in the pathogenesis of Salmonella. We recommend future outbreak studies investigate PPI usage to strengthen evidence on the relevance of PPIs in Salmonella infection. These findings should be used to support the development of guidelines for patients and prescribers on the risk of gastrointestinal infection and PPI usage.
authors.affiliation: Centre for Infectious Disease Surveillance and Control (CIDSC),Public Health England (PHE),London,UK.
authors.forename: R
authors.initials: R
authors.lastname: Freeman
authors.affiliation: Centre for Infectious Disease Surveillance and Control (CIDSC),Public Health England (PHE),London,UK.
authors.forename: G
authors.initials: G
authors.lastname: Dabrera
authors.affiliation: Centre for Infectious Disease Surveillance and Control (CIDSC),Public Health England (PHE),London,UK.
authors.forename: C
authors.initials: C
authors.lastname: Lane
authors.affiliation: Centre for Infectious Disease Surveillance and Control (CIDSC),Public Health England (PHE),London,UK.
authors.forename: N
authors.initials: N
authors.lastname: Adams
authors.affiliation: Health Protection Scotland,Glasgow,Scotland,UK.
authors.forename: L
authors.initials: L
authors.lastname: Browning
authors.affiliation: Field Epidemiology Service,PHE,Birmingham,UK.
authors.forename: T
authors.initials: T
authors.lastname: Fowler
authors.affiliation: Field Epidemiology Service,PHE,Newcastle,UK.
authors.forename: R
authors.initials: R
authors.lastname: Gorton
authors.affiliation: Colindale Reference Microbiology Services,PHE,London,UK.
authors.forename: T
authors.initials: T
authors.lastname: Peters
authors.affiliation: Scottish Salmonella,Shigella and Clostridium difficile Reference Laboratory,Glasgow,Scotland,UK.
authors.forename: H
authors.initials: H
authors.lastname: Mather
authors.affiliation: Colindale Reference Microbiology Services,PHE,London,UK.
authors.forename: P
authors.initials: P
authors.lastname: Ashton
authors.affiliation: Colindale Reference Microbiology Services,PHE,London,UK.
authors.forename: T
authors.initials: T
authors.lastname: Dallman
authors.affiliation: Colindale Reference Microbiology Services,PHE,London,UK.
authors.forename: G
authors.initials: G
authors.lastname: Godbole
authors.affiliation: Food Standards Agency,London,UK.
authors.forename: D
authors.initials: D
authors.lastname: Tubin-Delic
authors.affiliation: Centre for Infectious Disease Surveillance and Control (CIDSC),Public Health England (PHE),London,UK.
authors.forename: A
authors.initials: A
authors.lastname: Charlett
authors.affiliation: Centre for Infectious Disease Surveillance and Control (CIDSC),Public Health England (PHE),London,UK.
authors.forename: I
authors.initials: I
authors.lastname: Fisher
authors.affiliation: Centre for Infectious Disease Surveillance and Control (CIDSC),Public Health England (PHE),London,UK.
authors.forename: G K
authors.initials: GK
authors.lastname: Adak
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D004196:Disease Outbreaks; D004739:England / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D054328:Proton Pump Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D012307:Risk Factors; D012480:Salmonella Infections / Q000139:chemically induced / Q000453:epidemiology*; D019779:Salmonella enterica / Q000302:isolation & purification*; D012606:Scotland / Q000453:epidemiology; D014852:Wales / Q000453:epidemiology; D055815:Young Adult
chemical_list: D054328:Proton Pump Inhibitors
keywords: Epidemiology; gastroenteritis; outbreaks; salmonellosis