Thursday, June 18, 2009

Acid suppression and nosocomial pneumonia

A recent JAMA paper only confirms the long known association:

Using multivariable logistic regression, the adjusted OR of hospital-acquired pneumonia in the group exposed to acid-suppressive medication was 1.3 (95% CI, 1.1-1.4). The matched propensity-score analyses yielded identical results. The association was significant for proton-pump inhibitors (OR, 1.3; 95% CI, 1.1-1.4) but not for histamine2 receptor antagonists (OR, 1.2; 95% CI, 0.98-1.4).

Conclusions In this large, hospital-based pharmacoepidemiologic cohort, acid-suppressive medication use was associated with 30% increased odds of hospital-acquired pneumonia. In subset analyses, statistically significant risk was demonstrated only for proton-pump inhibitor use.

The recent emphasis on the ventilator bundle has created widespread confusion on this point. The bundle (sometimes known as the VAP bundle) has been touted as a process improvement to decrease the incidence of ventilator associated pneumonia, despite the fact that acid suppressive medication is one of the bundle components, and such treatment has long been known to increase pneumonia.

(Elsewhere I pointed out the lack of evidence in support of the bundle as a means to decrease pneumonia).

Many hospitalized patients are on PPIs for weak and sloppy indications. Better stewardship in the use of PPIs may help reduce nosocomial pneumonia.

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