Histamine H2-Blocker and Proton Pump Inhibitor Use and the Risk of Pneumonia in Acute Stroke: A Retrospective Analysis on Susceptible Patients

Arai, Nobuhiko; Nakamizo, Tomoki; Ihara, Hikaru; Koide, Takao; Nakamura, Ayako; Tabuse, Masanao; Miyazaki, Hiromichi

doi:10.1371/journal.pone.0169300

Cited by 28 publications

(32 citation statements)

References 29 publications

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“…Kalra et al [31] and Kalra et al [32] used the same RCT data. Study designs included RCTs (30%) [15,[31][32][33], prospective (20%) [13,34] and retrospective (40%) [35][36][37][38] observational studies and one quasi-experimental design [39]. Europe hosted 55% of studies [15,[31][32][33][34]37], Australia 27% [13,36,38] and Japan 18% [35,39].…”

Section: Resultsmentioning

confidence: 99%

“…Four studies reported pneumonia during hospitalization [33,34,37,39]. Three studies reported within 14 days of admission [31,32,35] and one from 7 days of admission [36]. Warusevitaine et al [15] and Langdon et al [13] reported at 21 days and 30 days, respectively.…”

Section: Diagnosis and Frequency Of Sapmentioning

confidence: 99%

“…Preventative antibiotics were administered in Nil by mouth (NBM) patients ≤ 48 h post onset of stroke symptoms [32]. In a second study, patients who were unable to eat orally for 14 days or more after admission were exposed to acid suppressive drugs: famotidine, a Histamine H2-Blocker (H2B), and omeprazole, a Proton Pump Inhibitor (PPI) [35]. The choice of drugs was at the discretion of the treating physician.…”

Section: Prophylactic Measuresmentioning

confidence: 99%

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Factors Associated with Risk of Stroke-Associated Pneumonia in Patients with Dysphagia: A Systematic Review

et al. 2019

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Dysphagia is associated with increased risk of stroke-associated pneumonia (SAP). However, it is unclear what other factors contribute to that risk or which measures may reduce it. This systematic review aimed to provide evidence on interventions and care processes associated with SAP in patients with dysphagia. Studies were screened for inclusion if they included dysphagia only patients, dysphagia and non-dysphagia patients or unselected patients that included dysphagic patients and evaluated factors associated with a recorded frequency of SAP. Electronic databases were searched from inception to February 2017. Eligible studies were critically appraised. Heterogeneity was evaluated using I 2. The primary outcome was SAP. Eleven studies were included. Sample sizes ranged from 60 to 1088 patients. There was heterogeneity in study design. Measures of immunodepression are associated with SAP in dysphagic patients. There is insufficient evidence to justify screening for aerobic Gram-negative bacteria. Prophylactic antibiotics did not prevent SAP and proton pump inhibitors may increase risk. Treatment with metoclopramide may reduce SAP risk. Evidence that nasogastric tube (NGT) placement increases risk of SAP is equivocal. A multidisciplinary team approach and instrumental assessment of swallowing may reduce risk of pneumonia. Patients with impaired mobility were associated with increased risk. Findings should be interpreted with caution given the number of studies, heterogeneity and descriptive analyses. Several medical interventions and care processes, which may reduce risk of SAP in patients with dysphagia, have been identified. Further research is needed to evaluate the role of these interventions and care processes in clinical practice.

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Section: Resultsmentioning

confidence: 99%

Section: Diagnosis and Frequency Of Sapmentioning

confidence: 99%

Section: Prophylactic Measuresmentioning

confidence: 99%

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Factors Associated with Risk of Stroke-Associated Pneumonia in Patients with Dysphagia: A Systematic Review

et al. 2019

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“…GERD is considered to be a risk factor for COPD exacerbations and this can further increase the mortality in this group of patients (73). The use of acid suppressing agents (histamine-2 receptor antagonists and proton pump inhibitors) which are commonly used in GERD are associated with an increased risk of stroke-associated pneumonia (SAP) (74,75). The compromised immune state and the use of corticosteroids already puts COPD patients at higher risk for pneumonia (76).…”

Section: Impact Of Stroke On Copd Outcomesmentioning

confidence: 99%

Chronic Obstructive Pulmonary Disease and Stroke

Corlăteanu

Covanţev

Mathioudakis

et al. 2018

COPD: Journal of Chronic Obstructive Pulmonary Disease

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Chronic obstructive pulmonary disease (COPD) is currently the fourth leading cause of death in the world and its incidence and prevalence is on the rise. It is evident that COPD is linked to cardiovascular disease. In the last years, several studies demonstrated that COPD may also be a risk factor for stroke, another major cause of death worldwide. Taking in consideration that COPD has multiple comorbidities it is hard to say whether COPD is an independent risk factor for stroke or it is due to confounding effect. This review is aimed to discuss current data on COPD and stroke, potential links, therapy, and prevention. Current data suggest that COPD may increase the risk of hemorrhagic stroke. The incidence of other stroke subtypes may also be increased in COPD or may be due to confounding effect. However, COPD patients who have stroke are at risk for pulmonary and extrapulmonary complications. We conclude that more studies are needed to further clarify the links between COPD and stroke. The management of COPD as well as the use of prevention therapy is essential to decrease the risk for stroke and should be at special attention in pulmonary medicine and neurology.

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“…There is emerging evidence for the use of preventative measures such as screening for stroke-induced immunosuppression and dysphagia, for identifying patients at high risk for SAP [15]. Further studies are needed to test this and screening for oral aerobic Gram-negative bacteria [16] as well as the need to evaluate if treatment with proton pump inhibitors [17] and nasogastric tubes (NGT) [18][19][20] are associated with SAP in patients with dysphagia.…”

Section: Introductionmentioning

confidence: 99%

Variation in Dysphagia Assessment and Management in Acute Stroke: An Interview Study

et al. 2019

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1) Background: Patients with dysphagia are at increased risk of stroke-associated pneumonia. There is wide variation in the way patients are screened and assessed. The aim of this study is to explore staff opinions about current practice of dysphagia screening, assessment and clinical management in acute phase stroke. (2) Methods: Fifteen interviews were conducted in five English National Health Service hospitals. Hospitals were selected based on size and performance against national targets for dysphagia screening and assessment, and prevalence of stroke-associated pneumonia. Participants were purposefully recruited to reflect a range of healthcare professions. Data were analysed using a six-stage thematic process. (3) Results: Three meta themes were identified: delays in care, lack of standardisation and variability in resources. Patient, staff, and service factors that contribute to delays in dysphagia screening, assessment by a speech and language therapist, and delays in nasogastric tube feeding were identified. These included admission route, perceived lack of ownership for screening patients, prioritisation of assessments and staff resources. There was a lack of standardisation of dysphagia screening protocols and oral care. There was variability in staff competences and resources to assess patients, types of medical interventions, and care processes. (4) Conclusion: There is a lack of standardisation in the way patients are assessed for dysphagia and variation in practice relating to staff competences, resources and care processes between hospitals. A range of patient, staff and service factors have the potential to impact on stroke patients being assessed within the recommended national guidelines.

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Histamine H2-Blocker and Proton Pump Inhibitor Use and the Risk of Pneumonia in Acute Stroke: A Retrospective Analysis on Susceptible Patients

Cited by 28 publications

References 29 publications

Factors Associated with Risk of Stroke-Associated Pneumonia in Patients with Dysphagia: A Systematic Review

Factors Associated with Risk of Stroke-Associated Pneumonia in Patients with Dysphagia: A Systematic Review

Chronic Obstructive Pulmonary Disease and Stroke

Variation in Dysphagia Assessment and Management in Acute Stroke: An Interview Study

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