Chest
Volume 129, Issue 5, May 2006, Pages 1219-1225
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Original Research: Critical Care Medicine
Impact of Alcohol Abuse in the Etiology and Severity of Community-Acquired Pneumonia

https://doi.org/10.1378/chest.129.5.1219Get rights and content

Background and study objectives

Alcohol consumption is known to affect both systemic and pulmonary immunity, predisposing the patient to pulmonary infections. The aim of this study was to compare the etiology of disease, the antibiotic resistance of Streptococcus pneumoniae, the severity of disease, and the outcome of patients with alcohol abuse to those of nonalcoholic (NA) patients who have been hospitalized for community-acquired pneumonia (CAP).

Methods

From 1997 to 2001, clinical, microbiological, radiographic, and laboratory data, and follow-up variables of all consecutive patients who had been hospitalized with CAP were recorded. Patients were classified as alcoholic (A) [n = 128] or ex-alcoholic (EA) patients (n = 54) and were compared to NA patients (n = 1,165).

Results: S pneumoniae

was found significantly more frequently in all patients with alcohol misuse. As regards the rates of antibiotic resistance, invasive pneumococcal disease, and other microorganisms, no differences were found. The severity criteria for CAP according to the American Thoracic Society were more frequent in A patients, but mortality did not differ significantly. Multivariate analysis showed an independent association between pneumococcal CAP and alcoholism (A patients: odds ratio [OR], 1.6; p = 0.033; EA patients: OR, 2.1; p = 0.016).

Conclusions

We found an independent association between pneumococcal infection and alcoholism. Current alcohol abuse was associated with severe CAP. No significant differences were found in mortality, antibiotic resistance of S pneumoniae, and other etiologies.

Section snippets

Materials and Methods

All consecutive patients who had been hospitalized for CAP at our 1,000-bed teaching hospital were prospectively followed up from hospital admission to hospital discharge, from October 1996 to November 2001. CAP was defined as the presence of a new infiltrate seen on a chest radiograph together with symptoms that were suggestive of a lower respiratory tract infection and no alternative diagnosis during follow-up.11, 15 Patients with immunosuppression (eg, from solid organ or bone marrow

Results

Of the 1,511 patients who were hospitalized with CAP, 1,347 were included for analysis (Table 1). The data about daily ethanol ingestion were incomplete in 164 patients; therefore, they were withdrawn from the analysis. There were 128 A patients (10%), 54 EA patients (4%), and 1,165 NA patients (86%). A valid sample for microbiological diagnosis, including one or more samples from sputum, blood culture, urinary antigen (UAG) sample, bronchoalveolar secretions (BASs), PSB sample, or BALF, was

Discussion

The main findings of our study were the following: (1) patients with current or former alcohol abuse had an increased risk of acquiring a pneumococcal infection when compared to NA patients; (2) rates of antibiotic resistance and pneumococcal bacteremia did not differ among the groups; and (3) A patients presented with more severe forms of pneumonia. Alcoholism is known to be an important risk factor for pneumonia.10, 19, 20, 21 Alcohol abuse has been described to favor infection by specific

Acknowledgment

We want to thank Dr. Juan Caballeria from the Gastroenterology Department of the Hospital Clinic for his advice on the definitions regarding alcohol intake and liver disease.

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    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).

    This research was supported by research fellowship grants from the European Respiratory Society to Dr. de Roux in 2001 and to Dr. Cavalcanti in 2003. The study was supported by grants Fondo de Investigación Sanitaria 99–0505, Red Grupo de Insuficiencia respiratoria aguda-ISCII-03/063, Red Respira-Instituto de Salud Carlos III-RTIC-03/11.

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