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Nosocomial Pneumonia Risk and Stress Ulcer Prophylaxis: A Comparison of Pantoprazole vs Ranitidine in Cardiothoracic Surgery Patients.
Chest. 2009 Mar 24;
Authors: Miano TA, Reichert MG, Houle TT, Macgregor DA, Kincaid EH, Bowton DL
Background Stress ulcer prophylaxis (SUP) using ranitidine, a histamine H2 receptor antagonist, has been associated with an increased risk of ventilator-associated pneumonia. The proton-pump inhibitor pantoprazole is also commonly used for SUP. Proton-pump inhibitor use has been linked to an increased risk of community-acquired pneumonia. The objective of this study was to determine whether SUP with pantoprazole increases pneumonia risk compared to ranitidine in critically ill patients. Methods Our institution's cardiothoracic surgery database was used to retrospectively identify all patients that received SUP with pantoprazole or ranitidine, without crossover between agents. 887 patients were identified from 01/01/04 - 03/31/07, with 53 being excluded (30 pantoprazole, 23 ranitidine). Our analysis compared the incidence of nosocomial pneumonia in 377 patients that received pantoprazole with 457 patients that received ranitidine. Results Nosocomial pneumonia developed in 35 of 377 (9.3%) of the patients receiving pantoprazole, as compared to 7 of 457 (1.5%) of the patients receiving ranitidine (OR 6.6; 95% CI, 2.9-14.9). Twenty-three covariates were used to estimate the probability of receiving pantoprazole as measured by propensity score (C-index 0.77). Using this score, pantoprazole and ranitidine patients were stratified according to their probability of receiving pantoprazole. After propensity adjusted, multivariable logistic regression, pantoprazole treatment was found to be an independent risk factor for nosocomial pneumonia (OR 2.7; 95% CI, 1.1-6.7, p = 0.034). Conclusion The use of pantoprazole for SUP was associated with a higher risk of nosocomial pneumonia compared to ranitidine. This relationship warrants further study in a randomized controlled trial.
PMID: 19318661 [PubMed - as supplied by publisher]