PMID- 19318661
OWN - NLM
STAT- MEDLINE
DCOM- 20090902
LR  - 20220408
IS  - 1931-3543 (Electronic)
IS  - 0012-3692 (Linking)
VI  - 136
IP  - 2
DP  - 2009 Aug
TI  - Nosocomial pneumonia risk and stress ulcer prophylaxis: a comparison of 
      pantoprazole vs ranitidine in cardiothoracic surgery patients.
PG  - 440-447
LID - S0012-3692(09)60481-5 [pii]
LID - 10.1378/chest.08-1634 [doi]
AB  - 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 (PPI) pantoprazole is 
      also commonly used for SUP. PPI 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 with ranitidine 
      in critically ill patients. METHODS: The cardiothoracic surgery database at our 
      institution was used to identify retrospectively all patients who had received 
      SUP with pantoprazole or ranitidine, without crossover between agents. From 
      January 1, 2004, to March 31, 2007, 887 patients were identified, with 53 
      patients excluded (pantoprazole, 30 patients; ranitidine, 23 patients). Our 
      analysis compared the incidence of nosocomial pneumonia in 377 patients who 
      received pantoprazole with 457 patients who received ranitidine. RESULTS: 
      Nosocomial pneumonia developed in 35 of the 377 patients (9.3%) who received 
      pantoprazole, compared with 7 of the 457 patients (1.5%) who received ranitidine 
      (odds ratio [OR], 6.6; 95% confidence interval [CI], 2.9 to 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 to 6.7; p = 0.034). CONCLUSION: The use of 
      pantoprazole for SUP was associated with a higher risk of nosocomial pneumonia 
      compared with ranitidine. This relationship warrants further study in a 
      randomized controlled trial.
FAU - Miano, Todd A
AU  - Miano TA
AD  - Department of Pharmacy, Hospital of the University of Pennsylvania, Philadelphia, 
      PA. Electronic address: tmiano81@gmail.com.
FAU - Reichert, Marc G
AU  - Reichert MG
AD  - Department of Pharmacy, North Carolina Baptist Hospital, Winston Salem, NC.
FAU - Houle, Timothy T
AU  - Houle TT
AD  - Departments of Anesthesiology, Wake Forest University School of Medicine, Winston 
      Salem, NC.
FAU - MacGregor, Drew A
AU  - MacGregor DA
AD  - Departments of Anesthesiology, Wake Forest University School of Medicine, Winston 
      Salem, NC.
FAU - Kincaid, Edward H
AU  - Kincaid EH
AD  - Cardiothoracic Surgery, Wake Forest University School of Medicine, Winston Salem, 
      NC.
FAU - Bowton, David L
AU  - Bowton DL
AD  - Departments of Anesthesiology, Wake Forest University School of Medicine, Winston 
      Salem, NC.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
DEP - 20090324
PL  - United States
TA  - Chest
JT  - Chest
JID - 0231335
RN  - 0 (2-Pyridinylmethylsulfinylbenzimidazoles)
RN  - 0 (Anti-Ulcer Agents)
RN  - 884KT10YB7 (Ranitidine)
RN  - D8TST4O562 (Pantoprazole)
SB  - IM
MH  - 2-Pyridinylmethylsulfinylbenzimidazoles/*adverse effects/therapeutic use
MH  - Adult
MH  - Age Distribution
MH  - Aged
MH  - Anti-Ulcer Agents/adverse effects/therapeutic use
MH  - Area Under Curve
MH  - Cohort Studies
MH  - Confidence Intervals
MH  - Cross Infection/*chemically induced/epidemiology/microbiology
MH  - Female
MH  - Follow-Up Studies
MH  - Humans
MH  - Incidence
MH  - Intensive Care Units
MH  - Logistic Models
MH  - Male
MH  - Middle Aged
MH  - Multivariate Analysis
MH  - Pantoprazole
MH  - Peptic Ulcer/drug therapy/*prevention & control
MH  - Pneumonia, Ventilator-Associated/*chemically induced/epidemiology/physiopathology
MH  - Postoperative Complications/drug therapy/prevention & control
MH  - Probability
MH  - Proportional Hazards Models
MH  - Ranitidine/*adverse effects/therapeutic use
MH  - Reference Values
MH  - Retrospective Studies
MH  - Risk Assessment
MH  - Sex Distribution
MH  - Statistics, Nonparametric
MH  - Thoracic Surgical Procedures/adverse effects/methods
MH  - Treatment Outcome
EDAT- 2009/03/26 09:00
MHDA- 2009/09/03 06:00
CRDT- 2009/03/26 09:00
PHST- 2009/03/26 09:00 [entrez]
PHST- 2009/03/26 09:00 [pubmed]
PHST- 2009/09/03 06:00 [medline]
AID - S0012-3692(09)60481-5 [pii]
AID - 10.1378/chest.08-1634 [doi]
PST - ppublish
SO  - Chest. 2009 Aug;136(2):440-447. doi: 10.1378/chest.08-1634. Epub 2009 Mar 24.