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Original Research: CRITICAL CARE MEDICINE |

Impact of Alcohol Abuse in the Etiology and Severity of Community-Acquired Pneumonia*

Andrés de Roux, MD, PhD; Manuela Cavalcanti, MD; Maria Angeles Marcos, MD, PhD; Elisa Garcia, MD; Santiago Ewig, MD, PhD, FCCP; José Mensa, MD, PhD; Antoni Torres, MD, PhD, FCCP
Author and Funding Information

*From the Servei de Pneumologia Institut del Tórax (Drs. de Roux, Cavalcanti, and Torres), the Servei de Microbiologia (Dr. Marcos), and the Servei de Malalties Infecciosas (Drs. Garcia and Mensa), Hospital Clinic, Institut d’Investigacions Biomèdiques August Pi i Sunyer, Facultad de Medicina Universidad de Barcelona, Barcelona, Spain; and the Pneumologische Klinik (Dr. Ewig), Augusta-Kranken-Anstalt, Bochum, Germany.

Correspondence to: Antoni Torres, MD, Servei de Pneumologia, Hospital Clinic, Villarroel 170, 08036 Barcelona, Spain; e-mail: atorres@ub.edu.



Chest. 2006;129(5):1219-1225. doi:10.1378/chest.129.5.1219
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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.


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