한국임상약학회지 (Korean Journal of Clinical Pharmacy)

  • 제26권1호
  • /
  • Pages.46-52
  • /
  • 2016
  • /
  • 1226-6051(pISSN)
  • /
  • 2508-786X(eISSN)
한국임상약학회 (Korean College Of Clinical Pharmacy)
권호 표지

중환자에서 스트레스성 궤양 예방 약물에 따른 감염성 합병증 발생률 비교

Comparison of Histamine 2 Receptor Antagonists and Proton Pump Inhibitors on Infectious Complications in Critically Ill Patients

  • 박선영 (이화여자대학교 임상보건과학대학원) ;
  • 최재희 (이화여자대학교 약학대학) ;
  • 윤영주 (강남세브란스병원 약제부) ;
  • 이정연 (이화여자대학교 임상보건과학대학원)
  • Park, Sun young (Graduate School of Clinical Health Sciences, Ewha Womans University) ;
  • Choi, Jae Hee (College of Pharmacy & Division of Life and Pharmaceutical Sciences and Graduate School of Clinical Health Sciences, Ewha Womans University) ;
  • Youn, Young Ju (Department of Pharmacy, Gangnam Severance Hospital) ;
  • Rhie, Sandy Jeong (Graduate School of Clinical Health Sciences, Ewha Womans University)
  • 투고 : 2015.12.28
  • 심사 : 2016.03.14
  • 발행 : 2016.03.31
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Background: The use of acid suppressive agents became a standard therapy in an intensive care unit (ICU) to prevent stress related gastrointestinal mucosal damage. However, the risk of infectious diseases has been concerned. Objective: The study was to determine the differences between histamine 2 receptor antagonists (H2RA) and proton pump inhibitors (PPI) in incidence of nosocomial pneumonia and pseudomembranous colitis (PMC) by Clostridium difficile with patients in ICU. Methods: This is a retrospective comparative study including patients admitted to the ICU who were at least 18 years of age and stayed for more than 48hrs from August 1, 2014 to January 31, 2015. The propensity score analysis and propensity matched multivariable logistic regression were used in analyzing data to control for confounders. Results: A total of 155 patients were assessed. H2RA were prescribed in 110 (53.9%) and PPI were in 45 (22.1%). Nosocomial pneumonia developed in 37 (23.9%); 25 (22.7%) were on H2RA and 12 (26.7%) were on PPI. The unadjusted incidence of nosocomial pneumonia was slightly higher in the patients with PPI (odds ratio (OR) 1.24; 95% confidence interval (CI): 0.54-2.71) compared to them with H2A. After adjusting with propensity score, the adjusted OR with PPI was 1.35 (95% CI: 0.44-4.11). The propensity score matched analyses showed similar results. Conclusion: The uses of PPI and H2RA as a stress ulcer prophylaxis agent showed similarity in the incidence of nosocomial pneumonia and PMC.

키워드

참고문헌

  1. Ali T, Harty RF. Stress-induced ulcer bleeding in critically ill patients. Gastroenterol Clin North Am 2009;38(2):245-65. https://doi.org/10.1016/j.gtc.2009.03.002
  2. Krag M, Perner A, Wetterslev J, et al. Stress ulcer prophylaxis in the intensive care unit: is it indicated? A topical systematic review. Acta Anaesthesiol Scand 2013;57(7):835-47. https://doi.org/10.1111/aas.12099
  3. Cook DJ, Witt LG, Cook RJ, et al. Stress ulcer prophylaxis in the critically ill: a meta-analysis. Am J Med 1991;91(5):519-27. https://doi.org/10.1016/0002-9343(91)90189-5
  4. Cook DJ, Griffith LE, Walter SD, et al. Canadian Critical Care Trials Group. The attributable mortality and length of intensive care unit stay of clinically important gastrointestinal bleeding in critically ill patients. Crit Care 2001;5(6):368-75. https://doi.org/10.1186/cc1071
  5. Fennerty MB. Pathophysiology of the upper gastrointestinal tract in the critically ill patient: rationale for the therapeutic benefits of acid suppression. Crit Care Med 2002;30(6 Suppl):S351-5. https://doi.org/10.1097/00003246-200206001-00002
  6. ASHP Therapeutic Guidelines on Stress Ulcer Prophylaxis. ASHP Commission on Therapeutics and approved by the ASHP Board of Directors on November 14, 1998. Am J Health Syst Pharm 1999; 56(4):347-79.
  7. Netzer P, Gaia C, Sandoz M, et al. Effect of repeated injection and continuous infusion of omeprazole and ranitidine on intragastric pH over 72 hours. Am J Gastroenterol 1999;94(2):351-7. https://doi.org/10.1016/S0002-9270(98)00738-2
  8. Levy MJ, Seelig CB, Robinson NJ, et al. Comparison of omeprazole and ranitidine for stress ulcer prophylaxis. Dig Dis Sci 1997;42(6): 1255-9. https://doi.org/10.1023/A:1018810325370
  9. Beaulieu M, Williamson D, Sirois C, et al. Do proton-pump inhibitors increase the risk for nosocomial pneumonia in a medical intensive care unit? J Critical Care 2008;23:513-8. https://doi.org/10.1016/j.jcrc.2007.11.003
  10. Howell MD, Novack V, Grgurich P, et al. Iatrogenic gastric acid suppression and the risk of nosocomial Clostridium difficile infection. Arch Intern Med 2010;170(9):784-90. https://doi.org/10.1001/archinternmed.2010.89
  11. Barletta JF, Sclar DA. Proton pump inhibitors increase the risk for hospital-acquired Clostridium difficile infection in critically ill patients. Crit Care 2014;18(6):714. https://doi.org/10.1186/s13054-014-0714-7
  12. Buendgens L, Bruensing J, Matthes M, et al. Administration of proton pump inhibitors in critically ill medical patients is associated with increased risk of developing Clostridium difficile-associated diarrhea. J Critical Care 2014; 696.e11-696.e15. https://doi.org/10.1016/j.jcrc.2014.03.002
  13. Herzig SJ, Howell MD, Ngo LH, et al. Acid-suppressive medication use and the risk for hospital-acquired pneumonia. JAMA 2009; 301(20):2120-8. https://doi.org/10.1001/jama.2009.722
  14. Charlson ME, Pompei P, Ales KL, et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987;40(5):373-83. https://doi.org/10.1016/0021-9681(87)90171-8
  15. Kastner C, Armitage J, Kimble A, et al. The Charlson comorbidity score: a superior comorbidity assessment tool for the prostate cancer multidisciplinary meeting. Prostate Cancer Prostatic Dis 2006;9(3): 270-4. https://doi.org/10.1038/sj.pcan.4500889
  16. MacLaren R, Reynolds PM, Allen RR. Histamine-2 receptor antagonists vs proton pump inhibitors on gastrointestinal tract hemorrhage and infectious complications in the intensive care unit. JAMA Intern Med. 2014;174(4):564-74. https://doi.org/10.1001/jamainternmed.2013.14673
  17. Cook D, Guyatt G, Marshall J, et al. A comparison of sucralfate and ranitidine for the prevention of upper gastrointestinal bleeding in patients requiring mechanical ventilation. Canadian Critical Care Trials Group. N Engl J Med 1998;338(12):791-7. https://doi.org/10.1056/NEJM199803193381203
  18. Kantorova I, Svoboda P, Scheer P, et al. Stress ulcer prophylaxis in critically ill patients: a randomized controlled trial. Hepatogastroenterology. 2004;51(57):757-61.
  19. Daley RJ, Rebuck JA, Welage LS, et al. Prevention of stress ulceration: current trends in critical care. Crit Care Med 2004;32(10):2008-13. https://doi.org/10.1097/01.CCM.0000142398.73762.20
  20. Miano TA, Reichert MG, Houle TT, et al. Nosocomial pneumonia risk and stress ulcer prophylaxis: a comparison of pantoprazole vs ranitidine in cardiothoracic surgery patients. Chest 2009;136(2):440-7. https://doi.org/10.1378/chest.08-1634
  21. Herzig SJ, Doughty C, Lahoti S, et al. Acid-suppressive medication use in acute stroke and hospital-acqiored pneumonia. Ann Neurol 2014; 76:712-8. https://doi.org/10.1002/ana.24262
  22. Bateman BT, Bykov K, Choudhry NK, et al. Type of stress ulcer prophylaxis and risk of nosocomial pneumonia in cardiac surgical patients: cohort study. BMJ 2013;347:f5416. https://doi.org/10.1136/bmj.f5416
  23. Herzig SJ, Rothberg MB, Feinbloom DB, et al. Risk factors for nosocomial gastrointestinal bleeding and use of acid-suppressive medication in non-critically ill patients. J Gen Intern Med 2013;28(5):683-90. https://doi.org/10.1007/s11606-012-2296-x
  24. Fohl AL, Regal RE. Proton pump inhibitor-associated pneumonia: Not a breath of fresh air after all? World J Gastrointest Pharmacol Ther 2011;2(3):17-26. https://doi.org/10.4292/wjgpt.v2.i3.17
  25. Eom CS, Jeon CY, Lim JW et al. Use of acid-suppressive drugs and risk of pneumonia: a systematic review and meta-analysis. CMAJ 2011; 183(3):310-9. https://doi.org/10.1503/cmaj.092129
  26. Laheij RJ, Sturkenboom MC, Hassing RJ et al. Risk of communityacquired pneumonia and use of gastric acid-suppressive drugs. JAMA 2004;292(16):1955-60. https://doi.org/10.1001/jama.292.16.1955
  27. Sarkar M, Hennessy S, Yang YX. Proton-pump inhibitor use and the risk for community-acquired pneumonia. Ann Intern Med 2008; 149(6):391-8. https://doi.org/10.7326/0003-4819-149-6-200809160-00005
  28. Lin PC, Chang CH, Hsu PI et al. The efficacy and safety of proton pump inhibitors vs histamine-2 receptor antagonists for stress ulcer bleeding prophylaxis among critical care patients: a meta-analysis. Crit Care Med 2010;38(4):1197-205. https://doi.org/10.1097/CCM.0b013e3181d69ccf
  29. Barkun AN, Bardou M, Pham CQ, et al. Proton pump inhibitors vs. histamine 2 receptor antagonists for stress-related mucosal bleeding prophylaxis in critically ill patients: a meta-analysis. Am J Gastroenterol 2012;107(4):507-20. https://doi.org/10.1038/ajg.2011.474
  30. Alhazzani W, Alenezi F, Jaeschke RZ, et al. Proton pump inhibitors versus histamine 2 receptor antagonists for stress ulcer prophylaxis in critically ill patients: a systematic review and meta-analysis. Crit Care Med 2013;41(3):693-705. https://doi.org/10.1097/CCM.0b013e3182758734