Stress Ulcer Prophylaxis as a Risk Factor for Tracheal Colonization and Hospital-Acquired Pneumonia in Intensive Care Patients: Impact on Latency Time for Pneumonia

Abstract

SUMMARY Stress ulcer prophylaxis is associated with bacterial colonization of respiratory tract. The aims of our study were to determine risk factors for trachea colonization (TC), colonization of pharynx (CP) or stomach (CD) and hospital-acquired pneumonia (HAP), and divide the factors into those with high risk and low risk. The study population (ventilated intensive care unit (ICU) patients eligible to receive stress ulcer prophylaxis) was randomized to receive one of three different treatment protocols: ranitidine, sucralfate, and no stress ulcer prophylaxis (control group). Clinical data relative to pre-specified risk factors for TC or HAP were recorded, as follows: APACHE II score (second risk factor), duration of intubation or tracheotomy (third risk factor), duration of mechanical ventilation (fourth risk factor) and duration of hospitalization in the ICU (fifth risk factor). Gastric pH was recorded and microbiological data regarding stomach, pharynx and trachea were collected on the 1 st , 2 nd , 3 rd and 5 th day. Fifty-eight out of 81 patients developed HAP (including ventilator-associated pneumonia), which occurred later in patients with gastric content pH <4 or those that were tracheotomized. Stress ulcer prophylaxis was not associated with HAP; however, it was proved as a risk factor for TC. TC was detected in tracheotomized patients and was caused by gram-negative pathogens. CP was associated with TC, since the majority of patients had CP before TC. A combination of risk factors (APACHE II >18, age >65, mechanical ventilation and sedation) caused a higher incidence of HAP and lower incidence of TC. HAP was more frequent in patients staying in the ICU for >10 days and those with cardiovascular disease as the underlying disorder. Sedation and previous antibiotic therapy correlated with longer latent period (LAT), while higher values of gastric content pH were related to shorter LAT. The longest LAT was found in patients colonized with Acinetobacter spp. Risk factors that accelerated the occurrence of HAP were found to have caused previous colonization. A combination of risk factors increased the likelihood of TC and HAP, and shortened LAT between TC and HAP.

Stress ulcer prophylaxis in critically ill adult patients with sepsis at risk of gastrointestinal bleeding: a retrospective cohort study

“…It was still controversial whether SUP increases the risk of hospital-acquired pneumonia and CDI because SUP use might decrease gastric acidity, altering normal intestinal flora and the overgrowth of gastric bacteria. 21 The results of the present study did not correspond with previous studies, 11,22,23 which indicated that SUP use was associated with an increased risk of infectious complications. In our study, SUP use may have no impact on ICU or hospital LOS in this study population.…”

Prophylactic use of acid suppressants in adult acutely ill hospitalised patients: A systematic review with meta‐analysis and trial sequential analysis

“…The control group was placebo in 40 trials and no prophylaxis in 25 trials. Of note, five trials did not report on any of our outcomes and were thus not included in any quantitative analyses . Characteristics of the included trials are presented in Table and full schematic overview of results in Table , in the ESM.…”

“…Three trials were adjudicated as having overall low risk of bias; the remaining trials were adjudicated as having an overall high risk of bias (Figure 2). Only six and eight trials were adjudicated as low risk of bias in the domains for ‘selective reporting’ and ‘allocation concealment’ respectively. More than 75% of the trials were at unclear or high risk of financial bias (‘other bias’ domain), mostly because there were no declarations about funding at all.…”

High-Flow Nasal Cannula Combined with Prone Positioning as an Intubation Alternative in COVID-19: A Case Report and Review of the Literature

“…As shown in a study from China, in COVID-19 patients with PaO 2 /FIO 2 <300 mm Hg combining prone position with HFNC significantly improved ventilation-perfusion mismatch and proved to be a good strategy in avoiding intubation and reducing the medical staff workload 9 . It must also be noted that, although recently published data suggest that stress ulcer prophylaxis might increase the risk of bacterial superinfection 10 , in this patient it was not the case and the collected sputum specimens showed no pathogen growth.…”