PPI Use Linked to Increased Risk for Hospital-Acquired Pneumonia

[Raptor]

Proton-Pump Inhibitor Use Linked to Increased Risk for Hospital-Acquired Pneumonia

Proton-pump inhibitor use is linked to increased risk for hospital-acquired pneumonia, according to the results of a large, hospital-based pharmacoepidemiologic cohort study reported in the May 27 issue of the Journal of the American Medical Association

JAMA. 2009;301:2120-2128.

Study Highlights


tlhe study population consisted of inpatients from 1 Massachusetts medical center between 2004 and 2007. All study subjects were at least 18 years old and were hospitalized for at least 3 days

The main outcome of the study was the effect of the use of acid-suppressive therapy on the rate of hospital-acquired pneumonia, an outcome which was culled from hospital discharge codes. Acid-suppressive therapy could consist of either proton-pump inhibitors or histamine2 receptor antagonists.

The main result of the study was adjusted to account for 50 potential covariates.

63,878 patients provided data for study analysis. The median age was 54 years, and 37% were men. Approximately 70% of subjects were white.

52% of the entire study cohort received acid-suppressive therapy. Patients who received such therapy were more likely to receive a medicine service, have an emergent admission, and receive systemic steroids and anticoagulants vs patients who did not receive acid-suppressive therapy.

Conversely, patients who received nonsteroidal anti-inflammatory drugs were less likely to receive acid-suppressive therapy.

83% of subjects receiving acid-suppressive therapy were prescribed proton-pump inhibitors, and 23% received histamine2 receptor antagonists.

Hospital-acquired pneumonia occurred in 3.5% of subjects, including 4.9% of those receiving acid-suppressive therapy and 2.0% of those not receiving such medications.

The adjusted odds ratio for hospital-acquired pneumonia associated with the use of acid-suppressive therapy was significant at 1.3.

The risk for aspiration pneumonia was particularly elevated with the use of acid-suppressive therapy.

On subgroup analysis based on treatment type, only patients receiving proton-pump inhibitors experienced a higher risk for hospital-acquired pneumonia.

An analysis that minimized characteristics between patients who did and did not receive acid-suppressive therapy failed to alter the main study outcome.
 
Researchers performed an analysis of the timing of acid-suppressive medications, and initiation of this therapy within 48 hours of admission was associated with a significant increase in the risk for hospital-acquired pneumonia.

Clinical Implications

A previous study found that although proton-pump inhibitor therapy did not affect the overall rate of community-acquired pneumonia or pneumonia causing hospitalization, recent initiation of proton-pump inhibitor therapy was associated with a higher risk for pneumonia.
The current study suggests that proton-pump inhibitors significantly increase the risk for hospital-acquired pneumonia, particularly aspiration pneumonia.