Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2013 Sep 19:347:f5416.
doi: 10.1136/bmj.f5416.

Type of stress ulcer prophylaxis and risk of nosocomial pneumonia in cardiac surgical patients: cohort study

Brian T Bateman  1 , Katsiaryna Bykov, Niteesh K Choudhry, Sebastian Schneeweiss, Joshua J Gagne, Jennifer M Polinski, Jessica M Franklin, Michael Doherty, Michael A Fischer, Jeremy A Rassen
Affiliations

Type of stress ulcer prophylaxis and risk of nosocomial pneumonia in cardiac surgical patients: cohort study

Brian T Bateman et al. BMJ. .

Abstract

Objective: To examine the relation between the type of stress ulcer prophylaxis administered and the risk of postoperative pneumonia in patients undergoing coronary artery bypass grafting.

Design: Retrospective cohort study.

Setting: Premier Research Database.

Participants: 21,214 patients undergoing coronary artery bypass graft surgery between 2004 and 2010; 9830 (46.3%) started proton pump inhibitors and 11,384 (53.7%) started H2 receptor antagonists in the immediate postoperative period.

Main outcome measure: Occurrence of postoperative pneumonia, assessed using appropriate diagnostic codes.

Results: Overall, 492 (5.0%) of the 9830 patients receiving a proton pump inhibitor and 487 (4.3%) of the 11,384 patients receiving an H2 receptor antagonist developed postoperative pneumonia during the index hospital admission. After propensity score adjustment, an elevated risk of pneumonia associated with treatment with proton pump inhibitors compared with H2 receptor antagonists remained (relative risk 1.19, 95% confidence interval 1.03 to 1.38). In the instrumental variable analysis, use of a proton pump inhibitor (compared with an H2 receptor antagonist) was associated with an increased risk of pneumonia of 8.2 (95% confidence interval 0.5 to 15.9) cases per 1000 patients.

Conclusions: Patients treated with proton pump inhibitors for stress ulcer had a small increase in the risk of postoperative pneumonia compared with patients treated with H2 receptor antagonists; this risk remained after confounding was accounted for using multiple analytic approaches.

PubMed Disclaimer

Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: SS is principal investigator of the Brigham and Women’s Hospital DEcIDE Center on Comparative Effectiveness Research and the DEcIDE Methods Center, both funded by the Agency for Healthcare Research and Quality, and of the Harvard-Brigham Drug Safety and Risk Management Research Center funded by the Food and Drug Administration; SS is a paid consultant to WHISCON LLC and Booz & Co, and he is principal investigator of investigator initiated grants to the Brigham and Women’s Hospital from Pfizer, Novartis, and Boehringer-Ingelheim unrelated to the topic of this study; JAR is a paid consultant to WHISCON LLC; no other relationships or activities that could appear to have influenced the submitted work.

Figures

None
Flow of patients through study. CABG=coronary artery bypass graft; H2RA=H2 receptor antagonist; PPI=proton pump inhibitor.
See this image and copyright information in PMC

Comment in

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Kollef MH, Sharpless L, Vlasnik J, Pasque C, Murphy D, Fraser VJ. The impact of nosocomial infections on patient outcomes following cardiac surgery. Chest 1997;112:666-75. - PubMed
    1. Leal-Noval SR, Marquez-Vacaro JA, Garcia-Curiel A, Camacho-Larana P, Rincon-Ferrari MD, Ordonez-Fernandez A, et al. Nosocomial pneumonia in patients undergoing heart surgery. Crit Care Med 2000;28:935-40. - PubMed
    1. Hortal J, Munoz P, Cuerpo G, Litvan H, Rosseel PM, Bouza E. Ventilator-associated pneumonia in patients undergoing major heart surgery: an incidence study in Europe. Crit Care 2009;13:R80. - PMC - PubMed
    1. Bouza E, Perez A, Munoz P, Jesus Perez M, Rincon C, Sanchez C, et al. Ventilator-associated pneumonia after heart surgery: a prospective analysis and the value of surveillance. Crit Care Med 2003;31:1964-70. - PubMed
    1. Pawar M, Mehta Y, Khurana P, Chaudhary A, Kulkarni V, Trehan N. Ventilator-associated pneumonia: incidence, risk factors, outcome, and microbiology. J Cardiothorac Vasc Anesth 2003;17:22-8. - PubMed

Publication types