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

Objective: To evaluate whether high alcohol intake is an independent r isk factor for community-acquired pneumonia in middle-aged people and whether it confers a poor prognosis. Methods: A two-phase study was pe rformed. Risk factors for community-acquired pneumonia were evaluated in a case-control study of 50 patients and 50 controls. Prognostic fac tors and microbiologic and clinical features were then evaluated in a cohort study of the 50 middle-aged patients with community-acquired pn eumonia. 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 incide nce 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 pharyn geal smears than did the nonalcoholics. Compared with nonalcoholic pat ients, alcoholic patients with pneumonia showed more severe clinical s ymptoms (P<.02), required longer intravenous treatment (P<.02) and lon ger hospital stay (P<.01), and had multilobar involvement and pleural effusion (both P<.01), as well as slower resolution of pulmonary infil trates. The only prognostic factor for mortality was high alcohol inta ke (P<.03). Conclusions: High alcohol intake is the main risk factor f or developing community-acquired pneumonia in middle-aged people. This situation also confers a worse prognosis in these patients, who shoul d be treated with broad-spectrum antibiotics for a longer period.