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Clinical question: Is the use of acid-suppressive medications associated with increased risk of hospital-acquired pneumonia (HAP) in nonventilated inpatients?

Background: Acid-suppressive medications are used frequently in the hospital setting, even though their use often is not evidence-based. Data suggests an association between acid-suppressive medication use and community-acquired pneumonia in the outpatient setting.

Study design: Prospective pharmacoepidemiologic cohort study.

Setting: Large urban academic medical center in Boston.

Synopsis: The cohort was 63,878 admissions of nonventilated patients hospitalized for at least three days. Acid-suppressive medications were prescribed in 52% of admissions; HAP occurred in 3.5% of admissions.

The unadjusted HAP incidence was higher in the group exposed to acid-suppressive medication, compared with the unexposed group (4.9% vs. 2.0%). After adjustment, the likelihood of HAP increased with the use of acid-suppressive medication (adjusted odds ratio, (95% C.I.), 1.3, (1.1 vs. 1.4)).

The matched propensity score analyses and sensitivity analyses yielded similar results. The relationship appeared slightly stronger for aspiration pneumonia compared with nonaspiration pneumonia.

When stratified by type of acid-suppressive medication, proton-pump inhibitors were associated with increased odds of HAP (AOR, (95% C.I.), 1.3 (1.1-1.4)), but histamine receptor antagonists were not (AOR, (95% C.I.), 1.2 (0.98-1.4).

This study was not powered appropriately to detect significance for an OR less than 1.3.

Bottom line: The use of acid-suppressive medications is associated with increased odds of HAP in nonventilated hospitalized patients.

Reference: Herzig SJ, Howell MD, Ngo LH, Marcantonio ER. Acid-suppressive medication use and the risk for hospital-acquired pneumonia. JAMA. 2009;301(20):2120-2128.

Reviewed for TH eWire by Alexander R. Carbo, MD, FHM; Suzanne Bertisch, MD, MPH; Lauren Doctoroff, MD; John Fani Srour, MD; Caleb Hale, MD; Nancy Torres-Finnerty, MD, FHM, Hospital Medicine Program, Beth Israel Deaconess Medical Center, Boston

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