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October 7, 2009

Acid-Suppressive Medication and Hospital-Acquired Pneumonia

JAMA. 2009;302(13):1415-1417. doi:10.1001/jama.2009.1413

To the Editor: Using multiple logistic regression analysis and propensity-matched analysis in a large cohort of non–critically ill hospitalized patients, Dr Herzig and colleagues1 demonstrated that the use of acid-suppressive medication was associated with a 30% increased odds ratio (OR) of hospital-acquired pneumonia (HAP). A randomized controlled trial supported prophylactic acid-suppressive therapy for patients with risk factors for stress ulcer bleeding, such as the use of anticoagulants and nonsteroidal anti-inflammatory drugs.2 In a cohort study of non–critically ill patients admitted to the medical service, 37.7% of the patients without such risk factors were given stress ulcer prophylaxis, mainly with proton-pump inhibitors.3 Recognized or possible risk factors for HAP include the presence of foreign bodies such as endotracheal and nasogastric tubes, prolonged hospital stay, increasing age, prior antibiotic exposure, major surgery, cigarette smoking, and acid-suppressive therapy,4 some of which were included in the multivariable logistic regression models in the study by Herzig et al.