Original articleAlimentary tractProphylaxis for Stress Ulcers With Proton Pump Inhibitors Is Not Associated With Increased Risk of Bloodstream Infections in the Intensive Care Unit
Section snippets
Methods
The institutional review board of Columbia University approved this study.
Study Population
From 60,764 patients initially evaluated for the study, 24,774 patients met eligibility criteria and were included in the analysis. A total of 756 patients (3.1%) developed BSI between days 3 and 30 of ICU stay. The mortality rate during the index ICU admission was 19% among patients who developed BSIs compared with 7.7% among patients who did not develop BSIs (P < .01). The incidence rate of BSIs was similar throughout the 7 years of the study (P for trend = .26).
Characteristics at Baseline and During Treatment in the Intensive Care Unit
Patients who received
Discussion
Use of PPIs for stress ulcer prophylaxis in the ICU was not associated with increased risk for BSI, and this null finding was robust through multiple sensitivity analyses. If the relationship between PPIs and BSI was mediated by PPI-induced changes in intestinal permeability, one might expect that PPIs would increase risk for BSI from enteric but not from non-enteric bacteria. However, there was also no association between PPIs and risk for BSI with predominantly enteric organisms.
References (38)
- et al.
Overall burden of bloodstream infection and nosocomial bloodstream infection in North America and Europe
Clin Microbiol Infect
(2013) - et al.
A new method of classifying prognostic comorbidity in longitudinal studies: development and validation
J Chronic Dis
(1987) Broad- and narrow-spectrum antibiotics: an unhelpful categorization
Clin Microbiol Infect
(1997)- et al.
Gut macromolecular permeability in pancreatitis correlates with severity of disease in rats
Gastroenterology
(1993) - et al.
Proton pump inhibitors increase incidence of nonsteroidal anti-inflammatory drug-induced small bowel injury: a randomized, placebo-controlled trial
Clin Gastroenterol Hepatol
(2016) - et al.
Proton pump inhibitors alter specific taxa in the human gastrointestinal microbiome: a crossover trial
Gastroenterology
(2015) - et al.
Acquired bloodstream infection in the intensive care unit: incidence and attributable mortality
Crit Care
(2011) - et al.
Characteristics and determinants of outcome of hospital-acquired bloodstream infections in intensive care units: the EUROBACT International Cohort Study
Intensive Care Med
(2012) - et al.
Intensive care unit-acquired blood stream infections: a 5-year retrospective analysis of a single tertiary care hospital in Korea
Infection
(2014) - et al.
An intervention to decrease catheter-related bloodstream infections in the ICU
N Engl J Med
(2006)
Impact of a prevention strategy targeting hand hygiene and catheter care on the incidence of catheter-related bloodstream infections
Crit Care Med
Impact of previous antibiotic therapy on outcome of Gram-negative severe sepsis
Crit Care Med
Eliminating catheter-related bloodstream infections in the intensive care unit
Crit Care Med
Proton pump inhibitors vs histamine 2 receptor antagonists for stress-related mucosal bleeding prophylaxis in critically ill patients: a meta-analysis
Am J Gastroenterol
ASHP therapeutic guidelines on stress ulcer prophylaxis: ASHP Commission on Therapeutics and approved by the ASHP Board of Directors on November 14, 1998
Am J Health Syst Pharm
Stress ulcer prophylaxis versus placebo or no prophylaxis in critically ill patients: a systematic review of randomised clinical trials with meta-analysis and trial sequential analysis
Intensive Care Med
Long-term use of antibiotics and proton pump inhibitors predict development of infections in patients with cirrhosis
Clin Gastroenterol Hepatol
Proton pump inhibitor use and risk of spontaneous bacterial peritonitis in cirrhotic patients: a systematic review and meta-analysis
Genet Mol Res
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Conflicts of interest The authors disclose no conflicts.
Funding Dr Freedberg was supported by a Research Scholar Award from the American Gastroenterological Association (AGA) and by the National Center for Advancing Translational Sciences, National Institutes of Health (NIH) (KL2 TR000081, formerly KL2 RR024157). The views expressed in this article represent those of the authors and do not necessarily represent the views of the AGA or the NIH. This project was also funded in part by the grant Health Information Technology to Reduce Healthcare-Associated Infections (R01-NR010822, Elaine Larson).