title: Proton pump inhibitor prophylaxis increases the risk of nosocomial pneumonia in patients with an intracerebral hemorrhagic stroke.
abstract: BACKGROUND
  Stress-related mucosal damage is an erosive process of the gastric lining resulting from abnormally high physiologic demands. To avoid the morbidity and mortality associated with significant bleeding from the damage, prophylaxis with an acid suppression medication is given. This is especially common in stroke victims. Recent studies have suggested a link between acid suppression therapy and nosocomial pneumonia, specifically implicating proton pump inhibitors (PPI), a potent acid suppression medication, as the culprit. In this retrospective study, we reviewed the medical records of admitted intracerebral hemorrhage (ICH) patients and determined if there is a link between PPI prophylaxis and nosocomial pneumonia in our ICH population.
  
  
  METHODS
  Medical records of 200 ICH patients admitted to the First Affiliated Hospital of Chongqing Medical University were reviewed from January 1, 2008 to October 31, 2009. PPIs were the only accepted form of acid suppression therapy. In all, 95 patients were given PPI prophylaxis, whereas 105 patients did not receive any form of acid suppression.
  
  
  RESULTS
  The unadjusted incidence rate of pneumonia in the PPI prophylactic group was 23.2%, and 10.5% in patients not having received prophylaxis. Additionally, patients treated with PPI prophylaxis were more likely to be critically ill, defined by an increase in conscious disturbance and dependency on mechanical ventilation and/or a nasogastric tube.
  
  
  CONCLUSIONS
  The use of a PPI as a prophylactic treatment against stress-related mucosal damage was associated with a higher occurrence of nosocomial pneumonia in our ICH population. This study suggests the need for further research investigating the use of PPI prophylaxis in ICH patients and the possibility of using alternate acid suppression therapeutic modalities.
authors: First Affiliated Hospital, Chongqing Medical University, Chongqing, China.
authors: Li
authors: L
authors: Ran
authors: Nikan H
authors: NH
authors: Khatibi
authors: Xinyue
authors: X
authors: Qin
authors: John H
authors: JH
authors: Zhang
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002543:Cerebral Hemorrhage / Q000188:drug therapy* / Q000209:etiology; D015331:Cohort Studies; D003428:Cross Infection / Q000139:chemically induced* / Q000150:complications; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000139:chemically induced* / Q000150:complications; D054328:Proton Pump Inhibitors / Q000009:adverse effects*; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D020521:Stroke / Q000150:complications
chemical_list: D054328:Proton Pump Inhibitors