Editorials

Acid suppressants and postoperative pneumonia

BMJ 2010; 340 doi: http://dx.doi.org/10.1136/bmj.c2254 (Published 21 June 2010) Cite this as: BMJ 2010;340:c2254
  1. Nimish Vakil, professor of medicine
  1. 1University of Wisconsin School of Medicine and Public Health, Aurora Medical Center, Summit, WI 53066 USA
  1. nvakil{at}wisc.edu

    The risk is uncertain, so prescription remains appropriate in selected patients

    Postoperative pneumonia is an important cause of morbidity and mortality in patients who have undergone surgery. A systematic review found that age over 60 years, mild or severe systemic disease (such as congestive heart failure and chronic obstructive pulmonary disease), reduced functional capacity, low serum albumin, and the type of surgery (patients having aortic aneurysm repair, thoracic surgery, and abdominal procedures have the highest risk) were associated with an increased risk.1 Gram negative organisms are the most commonly isolated.2 In the linked study (doi:10.1136/bmj.c2608), Redelmeier and colleagues assess whether gastric acid suppressants are associated with an increased risk of postoperative pneumonia in patients undergoing elective surgery.3

    After surgery, mechanically ventilated patients often develop colonisation of the oropharynx, oesophagus, and stomach with Gram negative organisms, and aspiration may occur despite the presence of an endotracheal tube. The source of the organisms causing the pneumonia is controversial. In one study, most of the organisms came from the stomach.4 Another found that oropharyngeal organisms were more important, and that selective decontamination of the oropharynx using topical antibiotics prevented postoperative …

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