title: A multicentre feasibility study evaluating stress ulcer prophylaxis using hospital-based registry data.
abstract: BACKGROUND
  It is unclear whether histamine-2 receptor blockers (H2RBs) or proton pump inhibitors (PPIs) are preferred for stress ulcer prophylaxis (SUP) in intensive care unit patients. Suitably powered comparative effectiveness trials are warranted.
  
  
  OBJECTIVE
  To establish the feasibility of collecting process-of-care and outcome data relevant to a proposed interventional trial of SUP using existing databases.
  
  
  METHODS
  A retrospective cohort study conducted in seven Australia and New Zealand tertiary ICUs, including all patients ≥18 years admitted between 1 January 2011 and 31 December 2012.
  
  
  METHODS
  Doses of dispensed PPIs and H2RBs, upper gastrointestinal bleeding events, upper respiratory tract colonisation with pathogenic bacteria, Clostridium difficile infections and inhospital mortality.
  
  
  RESULTS
  All sites were able to contribute to the study and investigators reported that data were generally easy to obtain. A median dose/ICU of 477 g of PPIs (interquartile range [IQR], 430.5-865 g), and 408.5 g (IQR, 109-1630.2 g) of H2RBs, were dispensed over the 2 years of the study. The median proportion of patients/ICU with upper GI bleeding complicating admission was 1.4% (IQR, 0.3%-1.8%). Colonisation of the respiratory tract with gram-negative bacteria occurred in a median of 7.1% of patients/ICU (IQR, 6.3%-14.1%). Pseudomembranous colitis occurred in hospital in a median of 1.4% of patients (IQR, 0.9%-2%) and inhospital mortality was 10.6% (95% CI, 9.5%- 11.7%).
  
  
  CONCLUSIONS
  It is feasible to use existing data sources to measure process-of-care and outcome data necessary for a registry-based interventional trial of SUP.
authors.affiliation: Department of Intensive Care, Royal Perth Hospital, Perth, WA, Australia. paul.young@ccdhb.org.nz.
authors.forename: Edward
authors.initials: E
authors.lastname: Litton
authors.affiliation: Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia.
authors.forename: Glenn M
authors.initials: GM
authors.lastname: Eastwood
authors.affiliation: Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia.
authors.forename: Rinaldo
authors.initials: R
authors.lastname: Bellomo
authors.affiliation: Medical Research Institute of New Zealand, Wellington, New Zealand.
authors.forename: Richard
authors.initials: R
authors.lastname: Beasley
authors.affiliation: Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Bailey
authors.affiliation: School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
authors.forename: Andrew B
authors.initials: AB
authors.lastname: Forbes
authors.affiliation: Intensive Care Services, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
authors.forename: David J
authors.initials: DJ
authors.lastname: Gattas
authors.affiliation: Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
authors.forename: David V
authors.initials: DV
authors.lastname: Pilcher
authors.affiliation: Department of Intensive Care, Royal Perth Hospital, Perth, WA, Australia.
authors.forename: Steven A R
authors.initials: SA
authors.lastname: Webb
authors.affiliation: Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
authors.forename: Shay P
authors.initials: SP
authors.lastname: McGuinness
authors.affiliation: Critical Care and Trauma Division, The George Institute for Global Health, Sydney, NSW, Australia.
authors.forename: Manoj K
authors.initials: MK
authors.lastname: Saxena
authors.affiliation: Department of Critical Care Medicine, Auckland City Hospital, Auckland, New Zealand.
authors.forename: Colin J
authors.initials: CJ
authors.lastname: McArthur
authors.affiliation: Medical Research Institute of New Zealand, Wellington, New Zealand.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Young
mesh_terms: D016360:Clostridioides difficile; D015331:Cohort Studies; D004761:Enterocolitis, Pseudomembranous / Q000209:etiology; D005240:Feasibility Studies; D006635:Histamine H2 Antagonists / Q000627:therapeutic use*; D006753:Hospital Records; D006801:Humans; D010437:Peptic Ulcer / Q000517:prevention & control*; D053717:Pneumonia, Ventilator-Associated / Q000209:etiology; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*; D012042:Registries; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D006635:Histamine H2 Antagonists; D054328:Proton Pump Inhibitors