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High Alcohol Intake as a Risk and Prognostic Factor for Community-Acquired Pneumonia

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 pneu 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.(Arch Intern Med. 1995;155:1649-1654) References 1. Torres A, Serra-Batlles A, Ferrer A, et al. Severe community-acquired pneumonia. Am Rev Respir Dis . 1991;144:312-318.Crossref 2. Marrie TJ, Durant H, Yates L. Community-acquired pneumonia requiring hospitalization: 5 year prospective study. Rev Infect Dis . 1989;4:586-599.Crossref 3. Örtqvist Ä, Hedlund J, Grillner L, et al. Aetiology, outcome and prognostic factors in community-acquired pneumonia requiring hospitalization. Eur Respir J . 1990;3:1105-1113. 4. Celis R, Torres A, Gatell JM, Almeda M, Rodriguez-Roisin R, Agusti Vidal A. Nosocomial pneumonia. Chest . 1988;93:318-324.Crossref 5. Woodhead MA, Macfarlane JT, McCracken JA, Rose DH, Finch RG. Prospective study of aetiology and outcome of pneumonia in the community. Lancet . 1987;1:671-674.Crossref 6. Ausina V, Coll P, Sambeat M, et al. Prospective study on the etiology of community-acquired pneumonia in children and adults in Spain. Eur J Microbiol Infect Dis . 1988;7:342-347.Crossref 7. Pachon L, Prados MD, Capote F, Cuello JA, Garnacho J, Verano A. Severe community-acquired pneumonia. Am Rev Respir Dis . 1990;142:369-373.Crossref 8. Generalitat de Catalunya, Departament de Sanitat i Seguretat Social. Pla de Salut de Catalunya 1993-1995 . Barcelona, Spain: CYAN Ed; 1994. 9. Capps JA, Coleman GH. Influence of alcohol on prognosis of pneumonia in Cook Country Hospital. JAMA . 1923;80:750-752.Crossref 10. Chomet B, Gach BM. Lobar pneumonia and alcoholism: an analysis of thirty-seven cases. Am J Med Sci . 1963;253:300-304.Crossref 11. Winterbauer RH, Bedon GA, Ball WC Jr. Recurrent pneumonia: predisposing illness and clinical patterns in 158 patients. Ann Intern Med . 1969;70:689-700.Crossref 12. Fang GD, Fine M, Orloff J, et al. New emerging etiologies for community-acquired pneumonia with implications for therapy. Medicine . 1990;69:307-316.Crossref 13. Krumpe PE, Cummiskey JM, Lillington GA. Alcohol and the respiratory tract. Med Clin North Am . 1984;68:201-219. 14. Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med . 1985;13:818-828.Crossref 15. Urbano-Márquez A, Estruch R, Navarro-López F, Grau JM, Mont L, Rubin E. The effects of alcoholism on skeletal and cardiac muscle. N Engl J Med . 1989; 320:409-415.Crossref 16. Fernández-Solà J, Estruch R, Grau JM, Paré JC, Rubin E, Urbano-Márquez A. The relation of alcoholic myopathy to cardiomyopathy. Ann Intern Med . 1989; 320:409-415. 17. Bush B, Shaw S, Clearly P, Delblanco T, Aronson MD. Screening for alcohol abuse using the CAGE questionnaire. Am J Med . 1987;82:231-235.Crossref 18. American Psychiatric Association, Committee on Nomenclature and Statistics. Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition . Washington, DC: American Psychiatric Press; 1987. 19. Godman L. Comparative reproducibility and validity of systems for assessing cardiovascular functional class. Circulation . 1981;64:1127-1234. 20. Jellife DB. The Assessment of the Nutritional Status of the Community . Geneva, Switzerland: World Health Organization; 1966. Monograph series, No. 53. 21. Blackburn GL, Bistrain BR, Maini BS, Shlamm MT, Smith MHF. Nutritional and metabolic assessment of the hospitalized patient. J Parenteral Enteral Nutr . 1977;1:11-22.Crossref 22. Durnin JV, Womersley JK. Body fat assessed from total density and its estimation from skinfold thickness. Br J Nutr . 1974;32:77-97.Crossref 23. Burrit MF, Anderson CF. Laboratory assessment of nutritional status. Hum Pathol . 1984;15:130-133.Crossref 24. Balows A. Respiratory tract: indigenous and pathogenic microorganisms of humans. In: Balows A, ed. Manual of Clinical Microbiology . 5th ed. Washington, DC: American Society for Microbiology; 1991:3-10. 25. Holt JG, ed. Berger's Manual of Systematic Bacteriology . Baltimore, Md: Williams & Wilkins; 1989. 26. Trapper ML. Infections complicating the alcoholic host. In: Grieco MH, ed. Infections in the Abnormal Host . New York, NY: Yorke Medical Books; 1980:474-507. 27. Nair MP, Kronfol ZA, Schwartz SA. Effects of alcohol and nicotine on cytotoxic functions of human lymphocytes. Clin Immunol Immunopathol . 1990;54:395-409.Crossref 28. Glassman A, Bennet CE, Randall L. Effects of ethyl alcohol on human peripheral lymphocytes. Arch Pathol Lab Med . 1985;109:540-542. 29. Spagnuolo PJ, MacGregor RR. Acute ethanol effect on chemotaxis and other components of host defense. J Lab Clin Med . 1975;86:24-35. 30. Guarnieri JJ, Laurenzi GA. Effect of alcohol on the mobilization of alveolar macrophages. J Lab Clin Med . 1968;72:40-51. 31. Watson RR, Jackson JC, Hartmann B, Sampliner R, Mobley D, Eskelson C. Cellular immune functions, endorphins, and alcohol consumption in males. Alcohol Clin Exp Res . 1985;9:248-254.Crossref 32. Mili F, Flanders D, Boring JR, Annerst JL, DeStefano F. The associations of alcohol drinking and drinking cessation to measures of the immune system in middle-aged men. Alcohol Clin Exp Res . 1992;16:688-694.Crossref 33. Adams HG, Jordan C. Infections in the alcoholic. Med Clin North Am . 1984; 68:179-200. 34. Berkowitz A, Reichel J, Shim C. The effect of ethanol on cough reflex. Clin Sci Mol Med . 1973;45:620-630. 35. Laurenzi GA, Guarnieri JJ. A study of the mechanisms of pulmonary resistance to infection. Am Rev Respir Dis . 1966;93:134-145. 36. Geokas MG, ed. Ethyl alcohol and disease. Med Clin North Am . 1984;68:1-245. 37. Charness ME, Simon RP, Greenberg DA. Ethanol and the nervous system. N Engl J Med . 1989;321:442-454.Crossref 38. Kaufman SE, Kaye MD. Induction of gastroesophageal reflux by alcohol. Gut . 1978;19:336-338.Crossref 39. Villalta J, Estruch JR, Antúnez E, Valls J, Urbano-Márquez A. Vagal neuropathy in chronic alcoholics. Alcohol Alcoholism . 1989;29:421-428. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

High Alcohol Intake as a Risk and Prognostic Factor for Community-Acquired Pneumonia

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Publisher
American Medical Association
Copyright
Copyright © 1995 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1995.00430150137014
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Abstract

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 pneu 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.(Arch Intern Med. 1995;155:1649-1654) References 1. Torres A, Serra-Batlles A, Ferrer A, et al. Severe community-acquired pneumonia. Am Rev Respir Dis . 1991;144:312-318.Crossref 2. Marrie TJ, Durant H, Yates L. Community-acquired pneumonia requiring hospitalization: 5 year prospective study. Rev Infect Dis . 1989;4:586-599.Crossref 3. Örtqvist Ä, Hedlund J, Grillner L, et al. Aetiology, outcome and prognostic factors in community-acquired pneumonia requiring hospitalization. Eur Respir J . 1990;3:1105-1113. 4. Celis R, Torres A, Gatell JM, Almeda M, Rodriguez-Roisin R, Agusti Vidal A. Nosocomial pneumonia. Chest . 1988;93:318-324.Crossref 5. Woodhead MA, Macfarlane JT, McCracken JA, Rose DH, Finch RG. Prospective study of aetiology and outcome of pneumonia in the community. Lancet . 1987;1:671-674.Crossref 6. Ausina V, Coll P, Sambeat M, et al. Prospective study on the etiology of community-acquired pneumonia in children and adults in Spain. Eur J Microbiol Infect Dis . 1988;7:342-347.Crossref 7. Pachon L, Prados MD, Capote F, Cuello JA, Garnacho J, Verano A. Severe community-acquired pneumonia. Am Rev Respir Dis . 1990;142:369-373.Crossref 8. Generalitat de Catalunya, Departament de Sanitat i Seguretat Social. Pla de Salut de Catalunya 1993-1995 . Barcelona, Spain: CYAN Ed; 1994. 9. Capps JA, Coleman GH. Influence of alcohol on prognosis of pneumonia in Cook Country Hospital. JAMA . 1923;80:750-752.Crossref 10. Chomet B, Gach BM. Lobar pneumonia and alcoholism: an analysis of thirty-seven cases. Am J Med Sci . 1963;253:300-304.Crossref 11. Winterbauer RH, Bedon GA, Ball WC Jr. Recurrent pneumonia: predisposing illness and clinical patterns in 158 patients. Ann Intern Med . 1969;70:689-700.Crossref 12. Fang GD, Fine M, Orloff J, et al. New emerging etiologies for community-acquired pneumonia with implications for therapy. Medicine . 1990;69:307-316.Crossref 13. Krumpe PE, Cummiskey JM, Lillington GA. Alcohol and the respiratory tract. Med Clin North Am . 1984;68:201-219. 14. Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med . 1985;13:818-828.Crossref 15. Urbano-Márquez A, Estruch R, Navarro-López F, Grau JM, Mont L, Rubin E. The effects of alcoholism on skeletal and cardiac muscle. N Engl J Med . 1989; 320:409-415.Crossref 16. Fernández-Solà J, Estruch R, Grau JM, Paré JC, Rubin E, Urbano-Márquez A. The relation of alcoholic myopathy to cardiomyopathy. Ann Intern Med . 1989; 320:409-415. 17. Bush B, Shaw S, Clearly P, Delblanco T, Aronson MD. Screening for alcohol abuse using the CAGE questionnaire. Am J Med . 1987;82:231-235.Crossref 18. American Psychiatric Association, Committee on Nomenclature and Statistics. Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition . Washington, DC: American Psychiatric Press; 1987. 19. Godman L. Comparative reproducibility and validity of systems for assessing cardiovascular functional class. Circulation . 1981;64:1127-1234. 20. Jellife DB. The Assessment of the Nutritional Status of the Community . Geneva, Switzerland: World Health Organization; 1966. Monograph series, No. 53. 21. Blackburn GL, Bistrain BR, Maini BS, Shlamm MT, Smith MHF. Nutritional and metabolic assessment of the hospitalized patient. J Parenteral Enteral Nutr . 1977;1:11-22.Crossref 22. Durnin JV, Womersley JK. Body fat assessed from total density and its estimation from skinfold thickness. Br J Nutr . 1974;32:77-97.Crossref 23. Burrit MF, Anderson CF. Laboratory assessment of nutritional status. Hum Pathol . 1984;15:130-133.Crossref 24. Balows A. Respiratory tract: indigenous and pathogenic microorganisms of humans. In: Balows A, ed. Manual of Clinical Microbiology . 5th ed. Washington, DC: American Society for Microbiology; 1991:3-10. 25. Holt JG, ed. Berger's Manual of Systematic Bacteriology . Baltimore, Md: Williams & Wilkins; 1989. 26. Trapper ML. Infections complicating the alcoholic host. In: Grieco MH, ed. Infections in the Abnormal Host . New York, NY: Yorke Medical Books; 1980:474-507. 27. Nair MP, Kronfol ZA, Schwartz SA. Effects of alcohol and nicotine on cytotoxic functions of human lymphocytes. Clin Immunol Immunopathol . 1990;54:395-409.Crossref 28. Glassman A, Bennet CE, Randall L. Effects of ethyl alcohol on human peripheral lymphocytes. Arch Pathol Lab Med . 1985;109:540-542. 29. Spagnuolo PJ, MacGregor RR. Acute ethanol effect on chemotaxis and other components of host defense. J Lab Clin Med . 1975;86:24-35. 30. Guarnieri JJ, Laurenzi GA. Effect of alcohol on the mobilization of alveolar macrophages. J Lab Clin Med . 1968;72:40-51. 31. Watson RR, Jackson JC, Hartmann B, Sampliner R, Mobley D, Eskelson C. Cellular immune functions, endorphins, and alcohol consumption in males. Alcohol Clin Exp Res . 1985;9:248-254.Crossref 32. Mili F, Flanders D, Boring JR, Annerst JL, DeStefano F. The associations of alcohol drinking and drinking cessation to measures of the immune system in middle-aged men. Alcohol Clin Exp Res . 1992;16:688-694.Crossref 33. Adams HG, Jordan C. Infections in the alcoholic. Med Clin North Am . 1984; 68:179-200. 34. Berkowitz A, Reichel J, Shim C. The effect of ethanol on cough reflex. Clin Sci Mol Med . 1973;45:620-630. 35. Laurenzi GA, Guarnieri JJ. A study of the mechanisms of pulmonary resistance to infection. Am Rev Respir Dis . 1966;93:134-145. 36. Geokas MG, ed. Ethyl alcohol and disease. Med Clin North Am . 1984;68:1-245. 37. Charness ME, Simon RP, Greenberg DA. Ethanol and the nervous system. N Engl J Med . 1989;321:442-454.Crossref 38. Kaufman SE, Kaye MD. Induction of gastroesophageal reflux by alcohol. Gut . 1978;19:336-338.Crossref 39. Villalta J, Estruch JR, Antúnez E, Valls J, Urbano-Márquez A. Vagal neuropathy in chronic alcoholics. Alcohol Alcoholism . 1989;29:421-428.

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Archives of Internal Medicine – American Medical Association

Published: Aug 7, 1995

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