High alcohol intake as a risk and prognostic factor for community-acquired pneumonia.

ABSTRACT

OBJECTIVE: To evaluate whether high alcohol intake is an independent risk factor for community-acquired pneumonia in middle-aged people and whether it confers a poor prognosis. METHODS: A two-phase study was performed. Risk factors for community-acquired pneumonia were evaluated in a case-control study of 50 patients and 50 controls. Prognostic factors and microbiologic and clinical features were then evaluated in a cohort study of the 50 middle-aged patients with community-acquired pneumonia. RESULTS: In the first study, the only independent risk factor for community-acquired pneumonia was high alcohol intake (P < .02). In the second study, patients with chronic alcoholism had a higher incidence of pneumonia caused by gram-negative bacilli (P < .03), as well as a higher incidence of Candida albicans (P < .03), Staphylococcus aureus (P < .0001), and gram-negative bacilli (P < .001) in the cultures of pharyngeal smears than did the nonalcoholics. Compared with nonalcoholic patients, alcoholic patients with pneumonia showed more severe clinical symptoms (P < .02), required longer intravenous treatment (P < .02) and longer hospital stay (P < .01), and had multilobar involvement and pleural effusion (both P < .01), as well as slower resolution of pulmonary infiltrates. The only prognostic factor for mortality was high alcohol intake (P < .03). CONCLUSIONS: High alcohol intake is the main risk factor for developing community-acquired pneumonia in middle-aged people. This situation also confers a worse prognosis in these patients, who should be treated with broad-spectrum antibiotics for a longer period.