HIGH ALCOHOL INTAKE AS A RISK AND PROGNOSTIC FACTOR FOR COMMUNITY-ACQUIRED PNEUMONIA

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.