SESSION TITLE: Respiratory Infections
SESSION TYPE: Original Investigation Slide
PRESENTED ON: Tuesday, October 28, 2014 at 11:00 AM - 12:15 PM
PURPOSE: Gastrointestinal symptoms are very common in the general population and a large percentage are on either prescribed or over the counter medication for acid suppression. It has been shown that reduction of gastric acid secretion permits colonization of the upper GI tract with oral bacteria and therefore has been associated as a risk factor for community acquired pneumonia (CAP) (Laheij et al. 2007). We designed a study to retrospectively evaluate the relationship of acid suppression with severity and outcome of patients admitted with CAP.
METHODS: We collected data of all patients (n=1020) admitted with CAP in our institution from 2010 to 2013. Patients with suspected aspiration pneumonia (n= 62) and those are immunosuppressed (either HIV or on immunosuppressive medication; n= 62) has been excluded from the study. Remainder 866 patients were divided into two groups- those are with or without acid suppression. These two groups were compared for the comorbidities, severity of presentation (laboratory values and radiologic evidence) and outcome (length of stay and mortality) using both t-test and regression analysis
RESULTS: Out of 866 patients included in our study, 48% were male (n=419), 86% were African American (n=747) and 53% were smokers (n= 450). 54% of the study subjects (n= 468) were on acid suppression. No significant differences were found between two study groups in terms of demographic characteristics but patients with other comorbidities like COPD, diabetes mellitus, previous stroke or neoplastic disease were also more likely to be on acid suppression. Patients with CAP who are on acid suppression were more likely to present with positive blood cultures (12% vs 5.5%; p< 0.001) and thrombocytopenia(22% vs 17%; p<0.001). Presence of radiological evidence of pneumonia was similar between the two groups (94% vs. 93.7%). Length of stay and mortality were higher in patients who are on acid suppression and these differences were reaching statistical significance (10.51 vs 8.96 and 15.1% vs 11.5% respectively, p=0.057 for both).
CONCLUSIONS: In our study, we found that patients with CAP who are on acid suppression are more severe on presentation (positive blood culture and thrombocytopenia) than their counterpart. The length of stay and mortality difference though statistically not significant but distinctly higher in patients on acid suppression.
CLINICAL IMPLICATIONS: Acid suppressing drugs should be used with caution and we strongly encourage using those medication only when indicated.
DISCLOSURE: The following authors have nothing to disclose: Bikash Bhattarai, Meenakshi Ghosh, Abhisekh Sinha Ray, Saurav Dwivedi, Chawmay Aye, Mohamed Mohamed, Chigodie Charles Agu, Saurav Pokharel, Rakesh Vadde, Vikram Oke, Marie Frances Schmidt, Danilo Enriquez, Joseph Quist, Anita Pandey, Saveena Manhas
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