RAPIDLY FATAL OUTCOME OF BACTEREMIC KLEBSIELLA-PNEUMONIAE PNEUMONIA IN ALCOHOLICS

Twenty-eight alcoholic patients with community-acquired pneumonia who were admitted to a referral medical center during a 3-year period were reviewed. All were men and with few exceptions were heavy smokers. Th e overall mortality was 64.3%. The most dramatic group was that of 11 patients (39.3%) with bacteremic Klebsiella pneumoniae pneumonia (BKPP ), which had high mortality rate (100%), short onset of illness before hospital admission (42.6+/-8.2 h, mean+/-SD), and short survival time after the admission (24.6+/-7.9 h). All these 11 patients needed inte nsive care unit (ICU) management and ventilatory support. Arterial blo od gas values showed marked hypoxemia and metabolic acidosis in most o f these 11 patients, and presence of shock at arrival in the hospital was noted in 8 patients. Acute renal failure and disseminated intravas cular coagulation developed in six patients. Chest radiographs showed pleural effusion and radiographic spread in nearly 50% of patients. Co mbination chemotherapy consisting of one aminoglycoside and one second - or third-generation cephalosporin was initiated in all patients. The rapidly fatal outcome of these 11 patients with BKPP despite manageme nt with adequate antibiotics and intensive care indicated the fulminan t nature of this disease. High virulence of the microorganism, altered immune response, and increased susceptibility to infection may all ha ve contributed to the fulminancy in this group of patients. The diseas e continues to present many difficulties in management.