Impact of proton pump inhibitors on infectious and wound outcomes in burn patients

Proton pump inhibitors (PPIs) are commonly used for stress ulcer prophylaxis in critically ill patients, but they have adverse effects such as heightened infection risk. We evaluated the complex risk-benefit profile and impact of PPI use on long-term clinical and wound healing outcomes in burn patients.

A retrospective analysis was conducted by using data extracted from the TriNetX database between 2015 and 2025. Adult patients receiving PPIs within one month of burn injury were identified (n= 52,100) and 1:1 propensity score matched to a control group of patients not receiving PPIs (n= 692,534). Outcomes were assessed using risk ratios (RR) at 90 days and 1-year post-burn; p-values < 0.05 were considered statistically significant.

After matching, each group included 42,239 patients. At 90 days post-burn, the PPI cohort showed significantly increased rates of pneumonia (RR=2.38), ventilator use (RR=2.13), sepsis (RR=2.91), mortality (RR=1.95), blood transfusion (RR=2.22), and hospital readmission (RR=1.40). Additionally, the PPI cohort showed elevated risk for wound dehiscence (RR=2.05), wound infection (RR=2.68), hematoma formation (RR=2.61), and seroma formation (RR=2.10). All outcomes remained significant at 1-year post-burn (p < 0.05).

Early PPI use after burn injury is associated with higher rates of infection, delayed wound healing, and increased mortality. It remains uncertain to what extent the observed complications reflect a direct effect of PPIs versus the severity of illness that prompted PPI use. Prospective studies are warranted to further compare the effects of different types of stress ulcer prophylaxis.