PMID- 22100573
OWN - NLM
STAT- MEDLINE
DCOM- 20120411
LR  - 20111221
IS  - 1537-6591 (Electronic)
IS  - 1058-4838 (Linking)
VI  - 54
IP  - 1
DP  - 2012 Jan 1
TI  - Risk of community-acquired pneumonia in veteran patients to whom proton pump 
      inhibitors were dispensed.
PG  - 33-42
LID - 10.1093/cid/cir767 [doi]
AB  - BACKGROUND: Observational studies linking proton pump inhibitor (PPI) exposure 
      with community-acquired pneumonia (CAP) have reported either modest or no 
      associations. Accordingly, we studied PPI exposure and CAP in veteran patients, 
      using a retrospective, nested case-control design. METHODS: From linked pharmacy 
      and administrative databases of the New England Veterans Healthcare System, we 
      identified 71985 outpatients newly prescribed PPIs between 1998 and 2007; 1544 
      patients met criteria for CAP subsequent to PPI initiation; 15440 controls were 
      matched through risk-set sampling by age and time under observation. Crude and 
      adjusted odds ratios comparing current with past PPI exposures, as well as tests 
      for interactions, were conducted for the entire and stratified samples. RESULTS: 
      Current PPI use associated with CAP (adjusted odds ratio [OR], 1.29 [95% 
      confidence interval CI, 1.15-1.45]). Risks were not substantially altered by 
      age or year of diagnosis. Dementia (n = 85; P = .062 for interaction) and 
      sedative/tranquilizer use (n = 224; P = .049 for interaction) were likely effect 
      modifiers increasing a PPI-CAP association; conversely, for some chronic medical 
      conditions, PPI-associated CAP risks were reversed. PPI exposures between 1 and 
      15 days increased CAP risks, compared with longer exposures, but PPI initiation 
      also frequently occurred shortly after CAP diagnoses. Prescribed PPI doses >1 
      dose/day also increased PPI-associated CAP risks. CONCLUSIONS: Among the veterans 
      studied, current compared with past PPI exposures associated modestly with 
      increased risks of CAP. However, our observations that recent treatment 
      initiation and higher PPI doses were associated with greater risks, and the 
      inconsistent PPI-CAP associations between patient subgroups, indicate that 
      further inquiries are needed to separate out coincidental patterns of 
      associations.
FAU - Hermos, John A
AU  - Hermos JA
AD  - Pharmaco-Epidemiology Group, Massachusetts Veterans Epidemiology Research and 
      Information Center, VA Cooperative Studies Program, VA Boston Healthcare System, 
      Boston, Massachusetts 02130, USA. john.hermos@va.gov
FAU - Young, Melissa M
AU  - Young MM
FAU - Fonda, Jennifer R
AU  - Fonda JR
FAU - Gagnon, David R
AU  - Gagnon DR
FAU - Fiore, Louis D
AU  - Fiore LD
FAU - Lawler, Elizabeth V
AU  - Lawler EV
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20111118
PL  - United States
TA  - Clin Infect Dis
JT  - Clinical infectious diseases : an official publication of the Infectious Diseases 
      Society of America
JID - 9203213
RN  - 0 (Proton Pump Inhibitors)
SB  - IM
MH  - Aged
MH  - Case-Control Studies
MH  - Community-Acquired Infections/*epidemiology
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - New England/epidemiology
MH  - Pneumonia
MH  - Pneumonia, Bacterial/*epidemiology
MH  - Proton Pump Inhibitors/*adverse effects/*therapeutic use
MH  - Retrospective Studies
MH  - Risk Assessment
MH  - Veterans
EDAT- 2011/11/22 06:00
MHDA- 2012/04/12 06:00
CRDT- 2011/11/22 06:00
PHST- 2011/11/22 06:00 [entrez]
PHST- 2011/11/22 06:00 [pubmed]
PHST- 2012/04/12 06:00 [medline]
AID - cir767 [pii]
AID - 10.1093/cid/cir767 [doi]
PST - ppublish
SO  - Clin Infect Dis. 2012 Jan 1;54(1):33-42. doi: 10.1093/cid/cir767. Epub 2011 Nov 
      18.