CoChat
Sign Up
Cited by 486Nosocomial Infections in ICUGastroesophageal reflux and treatmentsPneumonia and Respiratory Infections

Acid-suppressive medication use and the risk for hospital-acquired pneumonia

Herzig, Shoshana J.·2009·JAMA
DOI 10.1001/jama.2009.722
Open this paper in CoChat — free account

Abstract

CONTEXT: The use of acid-suppressive medication has been steadily increasing, particularly in the inpatient setting, despite lack of an accepted indication in the majority of these patients. OBJECTIVE: To examine the association between acid-suppressive medication and hospital-acquired pneumonia. DESIGN, SETTING, AND PATIENTS: Prospective pharmacoepidemiologic cohort study. All patients who were admitted to a large, urban, academic medical center in Boston, Massachusetts, from January 2004 through December 2007; at least 18 years of age; and hospitalized for 3 or more days were eligible for inclusion. Admissions with time spent in the intensive care unit were excluded. Acid-suppressive medication use was defined as any order for a proton-pump inhibitor or histamine(2) receptor antagonist. Traditional and propensity-matched multivariable logistic regression were used to control for confounders. MAIN OUTCOME MEASURE: Incidence of hospital-acquired pneumonia, defined via codes from the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM), in patients exposed and unexposed to acid-suppressive medication. RESULTS: The final cohort comprised 63 878 admissions. Acid-suppressive medication was ordered in 52% of admissions and hospital-acquired pneumonia occurred in 2219 admissions (3.5%). The unadjusted incidence of hospital-acquired pneumonia was higher in the group exposed to acid-suppressive medication than in the unexposed group (4.9% vs 2.0%; odds ratio [OR], 2.6; 95% confidence interval [CI], 2.3-2.8). Using multivariable logistic regression, the adjusted OR of hospital-acquired pneumonia in the group exposed to acid-suppressive medication was 1.3 (95% CI, 1.1-1.4). The matched propensity-score analyses yielded identical results. The association was significant for proton-pump inhibitors (OR, 1.3; 95% CI, 1.1-1.4) but not for histamine(2) receptor antagonists (OR, 1.2; 95% CI, 0.98-1.4). CONCLUSIONS: In this large, hospital-based pharmacoepidemiologic cohort, acid-suppressive medication use was associated with 30% increased odds of hospital-acquired pneumonia. In subset analyses, statistically significant risk was demonstrated only for proton-pump inhibitor use.

Integrity signals

Registry

Crossref · 10.1001/jama.2009.722

Cites

99 of 99 references verified0 citation errors · 0 not checkable

Statistics

Recomputing p-values needs the paper’s full text.

Claims the paper makes

This paper’s full text isn’t openly available, so its claims and self-check weren’t run. The registry and citation checks still apply.

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Proton-pump inhibitors decrease elimination of gastric microbiota and increase immigration of bacteria into the lungs, which increases the risk of pneumonia.

    “proton-pump inhibitors decrease elimination of gastric microbiota38 and increase immigration of bacteria into the lungs, which increases the risk of pneumonia.”

    From The microbiome and critical illness (2016) · cites this paper as [148]

Cites

Flagged first, then by citations

Cited by

Sorted by citations

Related

Authors
Herzig, S. J.
Affiliations
Beth Israel Deaconess Medical Center (US)
Corresponding author
Herzig, Shoshana J.
ORCID
Herzig, Shoshana J.
Venue
JAMA
Publisher
American Medical Association (AMA)
Published
2009-05-27
Volume
301
Issue
20
Pages
2120
ISSN
  • 0002-9955 (ISSN-L)
  • 0098-7484
DOI
10.1001/jama.2009.722
OpenAlex
W2139301698
Cited by
486
References
99
Citations by year
2026: 12 · 2025: 11 · 2024: 21 · 2023: 17 · 2022: 14 · 2021: 24 · 2020: 23 · 2019: 29 · 2018: 26 · 2017: 35 · 2016: 23 · 2015: 31 · 2014: 36 · 2013: 45 · 2012: 38
FWCI
33.71
Type
journal article
Language
en
Open access
closed
Locations
  • JAMA (publishedVersion)
  • PubMed (publishedVersion)
Funders
U.S. Public Health Service (T32-HP11001)
Topics
  • Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Nosocomial Infections in ICU
  • Health Sciences › Medicine › Gastroenterology › Gastroesophageal reflux and treatments
  • Health Sciences › Medicine › Epidemiology › Pneumonia and Respiratory Infections
Keywords
acid-suppressive medications, proton pump inhibitors, H2 receptor antagonists, nosocomial pneumonia, hospitalized patients, inpatient drug use, propensity score matching, pharmacoepidemiology
MeSH terms
Adult, Aged, Aged, 80 and over, Cross Infection, Drug Utilization, Female, Histamine H2 Antagonists, Hospitalization, Humans, Male, Middle Aged, Pneumonia, Prospective Studies, Risk, Reproducibility of Results, Comorbidity, Logistic Models, Pharmacoepidemiology, International Classification of Diseases, Proton Pump Inhibitors, Young Adult

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review