Acid‐Suppressive Medication Use in Acute Stroke and Hospital‐Acquired Pneumonia

ABSTRACT Objective: Pneumonia is a morbid complication of stroke, but evidence‐based strategies for its prevention are lacking. Acid‐suppressive medications have been associated with increased risk for nosocomial pneumonia in hospitalized patients. It is unclear whether these results can be extrapolated to stroke patients, where other factors strongly modulate pneumonia risk. We investigated the association between acid‐suppressive medication and hospital‐acquired pneumonia in patients with acute stroke. Methods: All patients hospitalized with acute ischemic stroke or intracerebral hemorrhage in a large, urban academic medical center in Boston, Massachusetts from 6/2000 ‐ 6/2010, ≥ 18 years of age and hospitalized for ≥ 2 days were eligible for inclusion. Acid‐suppressive medication use was defined as any pharmacy charge for a proton‐pump inhibitor or histamine‐2 receptor antagonist. Multivariable logistic regression was used to control for confounders. The main outcome measure was hospital‐acquired pneumonia, defined via ICD‐9‐CM codes. Results: The cohort comprised 1,676 admissions. Acid‐suppressive medication was ordered in 1,340 (80%) and hospital‐acquired pneumonia occurred in 289 (17.2%). The unadjusted incidence of hospital‐acquired pneumonia was higher in the group exposed to acid‐suppressive medication compared to unexposed (20.7% versus 3.6%, OR=7.0, 95% CI 3.9‐12.7). After adjustment, the OR of hospital‐acquired pneumonia in th...
Source: Annals of Neurology - Category: Neurology Authors: Tags: Research Article Source Type: research