Proton-Pump Inhibitors Might Be Associated with Pneumonia in Stroke Patients

In some hospitals, stroke patients are routinely given acid-suppressive therapy with proton-pump inhibitors (PPIs) or histamine-2–receptor antagonists (H₂RAs) for “prophylaxis,” despite no evidence to support this practice. In fact, acid-suppressive therapy could be harmful, because observational data in various patient populations suggest an association with elevated risk for pneumonia. In this retrospective study from a Boston teaching hospital, researchers sought to determine whether acid-suppressive therapy in stroke patients was associated with excess risk for hospital-acquired pneumonia.

Among 1676 patients admitted with stroke (and hospitalized for at least 2 days) during a 10-year period, 80% received acid-suppressive therapy (usually PPIs). The incidence of hospital-acquired pneumonia was 17%. In multivariate analysis with adjustment for 30 potential confounders (including mechanical ventilation), PPI use was associated with significantly higher risk for pneumonia (odds ratio, 2.7); a smaller elevated risk with H₂RA use (OR, 1.6) was not significant.