Do proton pump inhibitors increase the incidence of nosocomial pneumonia and related infectious complications when compared with histamine-2 receptor antagonists in critically ill trauma patients?
BACKGROUND
Proton pump inhibitors (PPI) may increase the risk of nosocomial pneumonia caused by profound irreversible gastric acid suppression. The study purpose was to characterize differences in nosocomial pneumonia and related infections in trauma patients administered either histamine2-receptor antagonists (H2RA) or PPI.


METHODS
Observational evaluation of consecutive critically ill adult trauma patients administered either omeprazole or famotidine during a 22-month period. Nosocomial infection was evaluated daily based on published CDC definitions.


RESULTS
Eighty of 269 patients fulfilled study criteria. The PPI group (n = 40) exhibited increased baseline risk for infection, demonstrated by higher ISS (p = 0.020), more chest tube placements (p = 0.031), and increased chest trauma (p = 0.025). Overall number of patients infected per group included 33% and 40% of patients administered PPI and H2RA, respectively (p = 0.64). Despite baseline differences, the incidence of nosocomial infection was similar (p = 0.87), and extrapolation of pneumonia based on 1000 patient days revealed a ratio 51.7 vs 52.2 in the PPI vs H2RA groups, respectively, which was not significant (p = 0.99).


CONCLUSIONS
Proton pump inhibitor administration does not increase risk of nosocomial pneumonia or other nosocomial infections compared with H2RA therapy in the critically ill trauma patient.
Department of Pharmacotherapy, Fletcher Allen Health Care, Burlington, Vermont 05401, USA.
Stephanie
S
Mallow
Jill A
JA
Rebuck
Turner
T
Osler
John
J
Ahern
Mark A
MA
Healey
Frederick B
FB
Rogers
D000293:Adolescent; D000328:Adult; D016638:Critical Illness; D003428:Cross Infection / Q000209:etiology*; D004791:Enzyme Inhibitors / Q000009:adverse effects*; D015738:Famotidine / Q000009:adverse effects*; D005260:Female; D006635:Histamine H2 Antagonists / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009853:Omeprazole / Q000009:adverse effects; D011014:Pneumonia / Q000209:etiology*; D054328:Proton Pump Inhibitors; D014947:Wounds and Injuries / Q000150:complications*
D004791:Enzyme Inhibitors; D006635:Histamine H2 Antagonists; D054328:Proton Pump Inhibitors; D015738:Famotidine; D009853:Omeprazole