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TomHsiung
Wed 29th April '15, 3:40pm
Jim Kling
November 05, 2014

AUSTIN, Texas — Acid suppressors are associated with more severe community-acquired pneumonia, according to a study of an inner-city hospital. However, comorbidities like diabetes and chronic obstructive pulmonary disease (COPD) could have played a role in the results.

"I looked through the literature and found there was a high association between acid suppression and ventilator-associated pneumonia," Bikash Bhattarai, MD, who was chief resident and is now a pulmonary fellow at the Interfaith Medical Center in Brooklyn, New York, told Medscape Medical News.

Previous research has shown that acid suppression can increase susceptibility to community-acquired pneumonia, possibly because reducing gastric acid secretion enhances colonization of the upper gastrointestinal tract with oral bacteria.

However, none of the subjects in those studies were black. "We have a huge African American population, so that's what prompted me to do the study," Dr Bhattarai explained here at CHEST 2014.

His team conducted a retrospective analysis of all patients with community-acquired pneumonia admitted to their inner-city hospital from 2010 to 2013 to determine whether there was an association with acid suppression. Patients who were suspected of having aspiration pneumonia or who were immunosuppressed in any way were excluded from the analysis.

In the study cohort, 86% of patients were black and 53% smoked. Although there were no fundamental differences in demographic characteristics, there was more use of acid suppression at the time of hospital admission in patients with certain comorbidities.

Table 1. Association Between Acid Suppression and Comorbidities


Comorbidity
Acid Suppression (n = 468), %
No Acid Suppression (n = 398), %


COPD
27.1
22.4


Diabetes mellitus
38.9
28.6


Previous stroke
14.1
8.5


Cancer
12.2
7.3


Chronic kidney disease
28.4
22.6



Physicians are very comfortable prescribing acid suppression. In fact, one meeting attendee said that the proportion of patients with community-acquired pneumonia on acid suppressors was surprisingly low (46%). But the results of the study suggest that the agents should be used more judiciously, said Dr Bhattarai.

"Even when the patient comes to the hospital, I'm not very comfortable discontinuing the acid suppressors, and my reflex is to put them on the medication if they're not on it already. But we shouldn't give these medications if they aren't indicated because there are risks," he said.

There was also an association between acid suppression and indicators of the severity of community-acquired pneumonia, some of which fell just short of statistical significance.

Table 2. Link Between Acid Suppression and Severity of Pneumonia


Indication of Severity
Acid Suppression (n = 468)
No Acid Suppression (n = 398)
P Value


Positive blood culture
12%
5.5%
<.001


Thrombocytopenia
22%
17%
<.001


Radiologic pneumonia
94%
93.7%



Length of hospital stay
10.51 days
8.96 days
.057


Mortality
15.1%
11.5%
.057



Still, not everyone is convinced by the data. The study was observational and relatively small, and confounding factors might explain the results, according to Punginathn Dorasamy, MBChB, professor of medicine at McMaster University in Hamilton, Ontario, Canada, who attended the presentation.

He pointed out that previous research has yielded conflicting results and, in one case, the study authors suspected that patients on acid suppressors had pre-existing conditions that predisposed them to pneumonia.

"It's difficult to say that acid suppression is contributing to the worsening of the pneumonia. But there may be a message that in a small subset of patients, such as those with diabetes or COPD, if we are suppressing the acid, we may increase the risk of severe types of pneumonia," Dr Dorasamy told Medscape Medical News.

Dr Bhattarai and Dr Dorasamy have disclosed no relevant financial relationships.

CHEST 2014: American College of Chest Physicians Meeting. Abstract 1972042. Presented October 28, 2014.

Forwarded from Medscape at http://www.medscape.com/viewarticle/834439?src=confwrap&uac=180112PN