Stress Ulcer Prophylaxis and Ventilation Pneumonia: Prevention by Antibacterial Cytoprotective Agents?

Abstract

The gastric and tracheal flora of 142 consecutive patients receiving stress ulcer prophylaxis were investigated, identifying identical isolates by typing. Furthermore, the growth pattern of normal respiratory bacteria and organisms causing ventilation pneumonia at different pH values and the in vitro effect of sucralfate and bismuth subsalicylate on these bacteria in simulated gastric fluid were studied. The results obtained were as follows: (1) with rising gastric pH bacterial counts in gastric aspirates, especially gram-negatives, increased significantly; (2) in 45 (31.7%) of the patients identical organisms were first isolated in gastric samples and one to two days later in tracheal secretions; (3) ventilation pneumonia was significantly more frequent in patients with high gastric pH; (4) pathogens causing ventilation pneumonia grew well in simulated gastric fluid at higher pH values, unlike normal respiratory organisms; and (5) sucralfate and bismuth subsalicylate showed antibacterial activity against frequent causative organisms of ventilation pneumonia.

Role of Gastric Colonization in Nosocomial Infections and Endotoxemia: A Prospective Study in Neurosurgical Patients on Mechanical Ventilation

“…However, our data do not support results from previous studies on intubated ICU patients, which suggested that gastric colonization was a significant risk factor for subsequent tracheal colonization or pneumonia [5,[8][9][10].…”

“…The results of this study confirm that intragastric microbial growth is pH-dependent [18][19][20] and promoted by treatment with Hs-receptor blockers or antacids [3][4][5][6][7][8]. However, our data do not support results from previous studies on intubated ICU patients, which suggested that gastric colonization was a significant risk factor for subsequent tracheal colonization or pneumonia [5,[8][9][10].…”

“…There was a positive correlation between gastric pH and log concentration of gram-negative bacilli (rs = .300, P = .0001), gram-positive cocci (rs = .675, P < .00001), anaerobes (rs = .501, P < .00001), and yeasts (rs = .252, P = .00 (8). Ninety-five percent of gram-negative bacilli, 93070 of gram-positive cocci, 97070 of anaerobes, and 58010 of yeasts were recovered from gastric aspirates with pH~4.…”

“…Previous reports suggest that the stomach is an additional source of organisms colonizing the trachea in intubated patients with high gastric pH [5,[8][9][10]. Six of 10 patients on mechanical ventilation reported by Atherton and White [10] had identical gastric and tracheal bacteria, and in three of these the organism was found in the stomach at least 1 d earlier than in the trachea.…”

“…The rise of gastric pH induced by such treatment promotes microbial colonization of the stomach [3][4][5][6][7][8]. Gastric microbial growth may predispose to tracheal colonization in intubated patients [5,[8][9][10], and possibly increase the risk for nosocomial pneumonia. Three recent studies of ICU patients receiving mechanical ventilation showed an association between nosocomial pneumonia and treatment with Receivedfor publication 1 November 1988and in revised form 24 April 1989. This work was presented in part at the Interscience Conference on Antimicrobial Agents and Chemotherapy, October 1988, Los Angeles.…”