In Reply: We agree with Dr Fujita that it is important to identify patients who are at highest risk for HAP and highest risk for stress ulcers to more accurately weigh the risks and benefits of prophylactic acid-suppressive medication use. Furthermore, as Fujita points out, it would be useful to know which risk factors for HAP are modified by acid-suppressive medication use. In our model there were 27 significant predictors of HAP. We performed stepwise variable selection methods as suggested by Fujita, but a small number of dominant predictors of HAP did not emerge. Therefore, the analyses required to examine effect modification between acid-suppressive medication and the 27 independent predictors of HAP in our cohort are beyond the scope of this reply.
Herzig SJ, Howell MD, Marcantonio ER. Acid-Suppressive Medication and Hospital-Acquired Pneumonia—Reply. JAMA. 2009;302(13):1415-1417. doi:10.1001/jama.2009.1416