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