Cited by 486Nosocomial Infections in ICUGastroesophageal reflux and treatmentsPneumonia and Respiratory Infections

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Acid-Suppressive Medication Use and the Risk for Hospital-Acquired Pneumonia

Herzig, Shoshana J.·2009·JAMA

DOI 10.1001/jama.2009.722

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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.

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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

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Acid-Suppressive Medication Use and the Risk for Hospital-Acquired Pneumonia

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