Do proton-pump inhibitors increase the risk for nosocomial pneumonia in a medical intensive care unit?

Purpose: The aim of this study was to determine whether the use of gastric acid-suppresive agents increases the risk of nosocomial pneumonia (NP) in a medical intensive care unit population. Materials and Methods: Retrospective cohort study in a medical intensive care unit of a 554-bed, university-affiliated, academic medical center. Results: A total of 924 medical records were included in the database during the Study Period of which 787 patients were included in the study. Out of this cohort, 104 patients (13.2%) eventually developed a NP. The risk for patients who received proton-pump inhibitors (adjusted hazard ratio [AHR] 0.63; 95% CI 0.39-1.01) was not significantly different than in non exposed patients. Variables most strongly associated with NP were the administration of sedatives or neuromuscular blockers for at least 2 consecutive days (AHR 3.39;95% CI 1.99-5.75) an Acute Physiology and Chronic Health Evaluation II (APACHE II) severity score greater than 15 (AHR, 3.34; 95%, CI 1.82-6.50), and presence of a central venous catheter (AHR 1.76; 95% CI 1.12-2.76). Conclusions: Prior use of a proton-pump inhibitor did not correlate with a significant increase in the risk of developing NP. This risk was higher with the administration of sedatives or neuromuscular blockers, increased disease severity, and placement of a central venous catheter. (c) 2008 Elsevier Inc. All rights reserved.