Acid suppression results in more severe CAP, poorer outcomes

AUSTIN, TEX. – Use of acid-suppressing drugs was associated with more severe presentation, longer hospital stay, and increased mortality among patients with community-acquired pneumonia presenting to an inner city community hospital, according to a retrospective analysis.

Of 866 patients admitted with community-acquired pneumonia (CAP) between 2010 and 2013, 468 (54%) were on acid suppression, and those patients were significantly more likely than those not on acid suppression to present with positive blood cultures (12% vs. 5.5%) and thrombocytopenia (22% vs. 17%). The difference between the groups in length of stay (10.51 days vs. 8.96 days, respectively), and mortality (15.1% vs. 11.5%, respectively) trended toward significance, Dr. Bikash Bhattarai reported at the annual meeting of the American College of Chest Physicians.

Study subjects included 419 men and 447 women, most of whom (86%) were African American. About half (53%) were smokers. The study excluded patients with suspected aspiration pneumonia and those who were immunosuppressed.

The groups were similar with respect to demographic characteristics, but patients with comorbidities, including chronic obstructive pulmonary disease, diabetes, previous stroke, or neoplastic diseases, were more likely to be on acid suppression, said Dr. Bhattarai of the Interfaith Medical Center in Brooklyn, N.Y.

Gastrointestinal symptoms are very common in the general population – as is the use of either prescribed or over-the-counter medication for acid suppression to treat them, he said, adding that it has been shown that reduction of gastric acid secretion permits colonization of the upper gastrointestinal tract with oral bacteria and is therefore considered a risk factor for CAP.

The findings of this analysis are limited by the retrospective, observational nature of the study, and additional subgroup analyses – including an analysis based on whether patients in the acid suppression group were being treated with proton pump inhibitors or histamine₂ blockers could be useful, he said, acknowledging that some data suggest that proton pump inhibitor use is associated with greater risk.

“Acid-suppressing drugs should be used with caution, and we strongly encourage using those medications only when indicated,” he said.

Dr. Bhattarai reported having no disclosures.

AUSTIN, TEX. – Use of acid-suppressing drugs was associated with more severe presentation, longer hospital stay, and increased mortality among patients with community-acquired pneumonia presenting to an inner city community hospital, according to a retrospective analysis.

Of 866 patients admitted with community-acquired pneumonia (CAP) between 2010 and 2013, 468 (54%) were on acid suppression, and those patients were significantly more likely than those not on acid suppression to present with positive blood cultures (12% vs. 5.5%) and thrombocytopenia (22% vs. 17%). The difference between the groups in length of stay (10.51 days vs. 8.96 days, respectively), and mortality (15.1% vs. 11.5%, respectively) trended toward significance, Dr. Bikash Bhattarai reported at the annual meeting of the American College of Chest Physicians.

Study subjects included 419 men and 447 women, most of whom (86%) were African American. About half (53%) were smokers. The study excluded patients with suspected aspiration pneumonia and those who were immunosuppressed.

The groups were similar with respect to demographic characteristics, but patients with comorbidities, including chronic obstructive pulmonary disease, diabetes, previous stroke, or neoplastic diseases, were more likely to be on acid suppression, said Dr. Bhattarai of the Interfaith Medical Center in Brooklyn, N.Y.

Gastrointestinal symptoms are very common in the general population – as is the use of either prescribed or over-the-counter medication for acid suppression to treat them, he said, adding that it has been shown that reduction of gastric acid secretion permits colonization of the upper gastrointestinal tract with oral bacteria and is therefore considered a risk factor for CAP.

The findings of this analysis are limited by the retrospective, observational nature of the study, and additional subgroup analyses – including an analysis based on whether patients in the acid suppression group were being treated with proton pump inhibitors or histamine₂ blockers could be useful, he said, acknowledging that some data suggest that proton pump inhibitor use is associated with greater risk.

“Acid-suppressing drugs should be used with caution, and we strongly encourage using those medications only when indicated,” he said.

Dr. Bhattarai reported having no disclosures.

AUSTIN, TEX. – Use of acid-suppressing drugs was associated with more severe presentation, longer hospital stay, and increased mortality among patients with community-acquired pneumonia presenting to an inner city community hospital, according to a retrospective analysis.

Of 866 patients admitted with community-acquired pneumonia (CAP) between 2010 and 2013, 468 (54%) were on acid suppression, and those patients were significantly more likely than those not on acid suppression to present with positive blood cultures (12% vs. 5.5%) and thrombocytopenia (22% vs. 17%). The difference between the groups in length of stay (10.51 days vs. 8.96 days, respectively), and mortality (15.1% vs. 11.5%, respectively) trended toward significance, Dr. Bikash Bhattarai reported at the annual meeting of the American College of Chest Physicians.

Study subjects included 419 men and 447 women, most of whom (86%) were African American. About half (53%) were smokers. The study excluded patients with suspected aspiration pneumonia and those who were immunosuppressed.

The groups were similar with respect to demographic characteristics, but patients with comorbidities, including chronic obstructive pulmonary disease, diabetes, previous stroke, or neoplastic diseases, were more likely to be on acid suppression, said Dr. Bhattarai of the Interfaith Medical Center in Brooklyn, N.Y.

Gastrointestinal symptoms are very common in the general population – as is the use of either prescribed or over-the-counter medication for acid suppression to treat them, he said, adding that it has been shown that reduction of gastric acid secretion permits colonization of the upper gastrointestinal tract with oral bacteria and is therefore considered a risk factor for CAP.

The findings of this analysis are limited by the retrospective, observational nature of the study, and additional subgroup analyses – including an analysis based on whether patients in the acid suppression group were being treated with proton pump inhibitors or histamine₂ blockers could be useful, he said, acknowledging that some data suggest that proton pump inhibitor use is associated with greater risk.

“Acid-suppressing drugs should be used with caution, and we strongly encourage using those medications only when indicated,” he said.

Dr. Bhattarai reported having no disclosures.