title: Incidence of pneumonia in mechanically ventilated patients treated with sucralfate or cimetidine as prophylaxis for stress bleeding: bacterial colonization of the stomach.
abstract: Retrograde colonization of the oropharynx from the stomach by microaspiration of gastric fluid is a recently recognized phenomenon associated with increased gastric pH that may result in pneumonia during ventilation therapy. In a prospective study we investigated 104 mechanically ventilated patients in the intensive care unit who were receiving sucralfate (n = 49) or cimetidine (n = 55) for stress ulcer prophylaxis. The incidence of pneumonia was 45.5% (25 patients) in the cimetidine group and 26.5% (13 patients) in the sucralfate group (95% confidence interval 0.98 to 6.97; odds ratio 2.61; p = 0.0549). Mortality rates were 18.4% (9 patients) in the sucralfate group versus 25.5% (14 patients) in the cimetidine group (p = 0.48). The mean pH values of gastric aspirates were significantly lower in patients treated with sucralfate than in patients receiving cimetidine (p = 0.044). The number of colony-forming units of Enterobacteriaceae in gastric aspirates was also significantly lower in the sucralfate group (p = 0.0037).
authors.affiliation: Department of Hospital Epidemiology, University Hospital Freiburg, Germany.
authors.forename: I
authors.initials: I
authors.lastname: Kappstein
authors.forename: G
authors.initials: G
authors.lastname: Schulgen
authors.forename: T
authors.initials: T
authors.lastname: Friedrich
authors.forename: P
authors.initials: P
authors.lastname: Hellinger
authors.forename: A
authors.initials: A
authors.lastname: Benzing
authors.forename: K
authors.initials: K
authors.lastname: Geiger
authors.forename: F D
authors.initials: FD
authors.lastname: Daschner
mesh_terms: D000328:Adult; D001424:Bacterial Infections / Q000139:chemically induced / Q000150:complications* / Q000382:microbiology; D002927:Cimetidine / Q000009:adverse effects*; D015169:Colony Count, Microbial; D003428:Cross Infection / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality; D005260:Female; D005745:Gastric Acidity Determination; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D010437:Peptic Ulcer / Q000188:drug therapy / Q000209:etiology / Q000517:prevention & control; D011015:Pneumonia, Aspiration / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000009:adverse effects*; D012307:Risk Factors; D013272:Stomach Diseases / Q000139:chemically induced / Q000150:complications* / Q000382:microbiology; D013312:Stress, Physiological / Q000150:complications; D013392:Sucralfate / Q000009:adverse effects*; D014132:Trachea / Q000382:microbiology
chemical_list: D013392:Sucralfate; D002927:Cimetidine