Ventilator-associated pneumonia in critically ill african patients on stress ulcer prophylaxis

Background: Stress ulcer prophylaxis is an integral part of the care of the critically ill. Agents that alter gastric pH may predispose these patients to gastric colonisation, with subsequent pneumonia and/or sepsis. Cytoprotective agents such as sucralfate preserve gastric acidity and may be protective. Objective: To determine whether African patients on sucralfate as stress-ulcer prophylaxis have a lower incidence of gastric colonisation and ventilator-associated pneumonia than those on ranitidine. Design: Randomised case-control study Setting: Kenyatta National Hospital Intensive Care Unit Subjects: Patients on ventilatory support for 48 hours or more Interventions: Sixty-eight critically ill patients were randomly assigned to either ranitidine or sucralfate as stress ulcer prophylaxis. Paired samples were taken from gastric and tracheal aspirates at admission, 48 hours and day six. Pneumonia was diagnosed using the Clinical Pulmonary Infection Score. Main outcome measures: Death or the development of pneumonia. Results: Although gastric colonisation rates were similar in the two groups, the incidence of pneumonia was lower in the sucralfate group (17.6% vs. 23.5%, p=0.4). In 63.6% of patients with both gastric colonisation and airway infection, the same organism was isolated from the two sites (p<0.01). The majority of the organisms isolated were multi-drug resistant. Conclusion: Compared with ranitidine, sucralfate did not offer significant reduction in either gastric colonisation or ventilator-associated pneumonia in critically ill African patients.