Risk of Hospital-Acquired Infection from Proton Pump Inhibitors Use in Critically Ill Patients: A Systematic Review and Meta-Analysis

Objectives Hospital acquired infection (HAI) is a significant concern for patients and healthcare systems with patients in intensive care units (ICU) at higher risk. Proton pump inhibitors (PPI) are used for stress ulcer prophylaxis and studies reported mixed results on its relationship with risk of infections. This systematic review assessed the association between PPI use and HAI and its impact on infection in ICU. Design Studies were identified through electronic searches of PubMed, Web of Science, Scopus, and Google Scholar between Inception and January 2025. Included studies were those conducted in hospital intensive care unit settings and examined PPI use. Studies that included patients with infection prior PPI use and those without ICU settings confirmed were excluded. Quantitative synthesis and random effect meta-analyses were performed in RevMan 5.4.1. Results The review yielded 16 studies among which Clostridioides difficile was the most frequently reported infection. Across studies, concomitant antibiotic exposure consistently emerged as an important factor associated with infection risk. There was statistically and clinically significant association between PPI use and increased risk of HAIs in ICU patients, while a smaller number reported null or mixed associations. Conclusions These findings underscore the importance of judicious PPI prescribing in ICU settings.