A multicentre feasibility study evaluating stress ulcer prophylaxis using hospital-based registry data.

Abstract

It is unclear whether histamine-2 receptor blockers (H2RBs) or proton pump inhibitors (PPIs) are preferred for stress ulcer prophylaxis (SUP) in intensive care unit patients. Suitably powered comparative effectiveness trials are warranted.To establish the feasibility of collecting process-of-care and outcome data relevant to a proposed interventional trial of SUP using existing databases.A retrospective cohort study conducted in seven Australia and New Zealand tertiary ICUs, including all patients ≥18 years admitted between 1 January 2011 and 31 December 2012.Doses of dispensed PPIs and H2RBs, upper gastrointestinal bleeding events, upper respiratory tract colonisation with pathogenic bacteria, Clostridium difficile infections and inhospital mortality.All sites were able to contribute to the study and investigators reported that data were generally easy to obtain. A median dose/ICU of 477 g of PPIs (interquartile range [IQR], 430.5-865 g), and 408.5 g (IQR, 109-1630.2 g) of H2RBs, were dispensed over the 2 years of the study. The median proportion of patients/ICU with upper GI bleeding complicating admission was 1.4% (IQR, 0.3%-1.8%). Colonisation of the respiratory tract with gram-negative bacteria occurred in a median of 7.1% of patients/ICU (IQR, 6.3%-14.1%). Pseudomembranous colitis occurred in hospital in a median of 1.4% of patients (IQR, 0.9%-2%) and inhospital mortality was 10.6% (95% CI, 9.5%- 11.7%).It is feasible to use existing data sources to measure process-of-care and outcome data necessary for a registry-based interventional trial of SUP.